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CLINICAL STUDY: ARRHYTHMIAS

The electrophysiologic mechanism of ST-segment elevation in Brugada syndrome

Takashi Kurita, MD^*,*, Wataru Shimizu, MD^*, Masashi Inagaki, MD, Kazuhiro Suyama, MD^*, Atsushi Taguchi, MD^*, Kazuhiro Satomi, MD^*, Naohiko Aihara, MD^*, Shiro Kamakura, MD^*, Junjiro Kobayashi, MD and Yoshio Kosakai, MD

^* Division of Cardiology, National Cardiovascular Center, Suita, Osaka, Japan
Department of Cardiovascular Dynamics, National Cardiovascular Center, Suita, Osaka, Japan
Division of Cardiovascular Surgery, National Cardiovascular Center, Suita, Osaka, Japan

Manuscript received January 10, 2002; revised manuscript received April 16, 2002, accepted April 24, 2002.

^* Reprint requests and correspondence: Dr. Takashi Kurita, Division of Cardiology, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan.
kuritat{at}hsp.ncvc.go.jp

OBJECTIVES: We sought to demonstrate the electrophysiologic (EP) mechanism of the ST-T change in Brugada syndrome.

BACKGROUND: Brugada syndrome is characterized by various electrocardiographic manifestations (e.g., right bundle branch block, ST-segment elevation, and terminal T-wave inversion in the right precordial leads) and sudden cardiac death caused by ventricular fibrillation. Direct evidence in support of the EP mechanism underlying this intriguing syndrome has been lacking.

METHODS: Monophasic action potentials (MAPs) were obtained from three patients with the coved-type ST-segment elevation (Brugada patients) and five control patients using the contact electrode method. Epicardial MAPs were recorded during open-chest surgery in all patients.

RESULTS: A spike-and-dome configuration was documented from epicardial sites of the right ventricular (RV) outflow tract in all Brugada patients but not in control patients. Monophasic action potential recordings from the endocardium with special focus on the RV outflow tract could not demonstrate any morphological abnormalities in three Brugada patients.

CONCLUSIONS: The presence of a deeply notched action potential in the RV epicardium, but not in endocardium, would be expected to induce a transmural current that would contribute to elevation of the ST-segment in the right precordial leads. The spike-and-dome configuration may also prolong the epicardial action potential, thus contributing to a rapid reversal of the transmural gradients and inscription of an inverted T-wave.

Abbreviations and Acronyms   ECG   electrocardiogram/electrocardiographic   EP   electrophysiologic study/electrophysiologic   LV   left ventricle/ventricular   MAP   monophasic action potential   RV   right ventricular/ventricle   VF   ventricular fibrillation

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