High-density epicardial mapping in Brugada syndrome: Depolarization and repolarization abnormalities

Luigi Pannone; Cinzia Monaco; Antonio Sorgente; Pasquale Vergara; Paul-Adrian Calburean; Anaïs Gauthey; Antonio Bisignani; Shuichiro Kazawa; Antanas Strazdas; Joerelle Mojica; Felicia Lipartiti; Maysam Al Housari; Vincenzo Miraglia; Sergio Rizzi; Dimitrios Sofianos; Federico Cecchini; Thiago Guimarães Osório; Gaetano Paparella; Robbert Ramak; Ingrid Overeinder; Gezim Bala; Alexandre Almorad; Erwin Ströker; Gudrun Pappaert; Juan Sieira; Pedro Brugada; Mark La Meir; Gian Battista Chierchia; Carlo de Asmundis

doi:10.1016/j.hrthm.2021.09.032

High-density epicardial mapping in Brugada syndrome: Depolarization and repolarization abnormalities

Luigi Pannone, Cinzia Monaco, Antonio Sorgente, Pasquale Vergara, Paul-Adrian Calburean, Anaïs Gauthey, Antonio Bisignani, Shuichiro Kazawa, Antanas Strazdas, Joerelle Mojica, Felicia Lipartiti, Maysam Al Housari, Vincenzo Miraglia, Sergio Rizzi, Dimitrios Sofianos, Federico Cecchini, Thiago Guimarães Osório, Gaetano Paparella, Robbert Ramak, Ingrid OvereinderGezim Bala, Alexandre Almorad, Erwin Ströker, Gudrun Pappaert, Juan Sieira, Pedro Brugada, Mark La Meir, Gian Battista Chierchia, Carlo de Asmundis

Research output: Contribution to journal › Article › peer-review

28 Citations (Scopus)

Abstract

BACKGROUND: The pathogenesis of Brugada syndrome (BrS) and consequently of abnormal electrograms (aEGMs) found in the epicardium of the right ventricular outflow tract (RVOT-EPI) is controversial.

OBJECTIVE: The purpose of this study was to analyze aEGM from high-density RVOT-EPI electroanatomic mapping (EAM).

METHODS: All patients undergoing RVOT-EPI EAM with the HD-Grid catheter for BrS were retrospectively included. Maps were acquired before and after ajmaline, and all patients had concomitant noninvasive electrocardiographic imaging with annotation of RVOT-EPI latest activation time (RVOTat). High-frequency potentials (HFPs) were defined as ventricular potentials occurring during or after the far-field ventricular EGM showing a local activation time (HFPat). Low-frequency potentials (LFPs) were defined as aEGMs occurring after near-field ventricular activation showing fractionation or delayed components. Their activation time from surface ECG was defined as LFPat.

RESULTS: Fifteen consecutive patients were included in the study. At EAM before ajmaline, 7 patients (46.7%) showed LFPs. All patients showed HFPs before and after ajmaline and LFPs after ajmaline. Mean HFPat (134.4 vs 65.3 ms, P <.001), mean LFPat (224.6 vs 113.6 ms, P <.001), and mean RVOTat (124.8 vs 55.9 ms, P <.001) increased after ajmaline. RVOTat correlated with HFPat before (ρ = 0.76) and after ajmaline (ρ = 0.82), while RVOTat was shorter than LFPat before (P <.001) and after ajmaline (P <.001). BrS patients with history of aborted sudden cardiac death had longer aEGMs after ajmaline.

CONCLUSION: Two different types of aEGMs are described from BrS high-density epicardial mapping. This might correlate with depolarization and repolarization abnormalities.

Original language	English
Pages (from-to)	397-404
Number of pages	8
Journal	Heart Rhythm
Volume	19
Issue number	3
Early online date	2021
DOIs	https://doi.org/10.1016/j.hrthm.2021.09.032
Publication status	Published - Mar 2022

Bibliographical note

Keywords

Brugada syndrome
Electrocardiographic imaging
High-density mapping
Sudden cardiac death
Ventricular tachycardia ablation

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10.1016/j.hrthm.2021.09.032

Cite this

Pannone, L., Monaco, C., Sorgente, A., Vergara, P., Calburean, P-A., Gauthey, A., Bisignani, A., Kazawa, S., Strazdas, A., Mojica, J., Lipartiti, F., Al Housari, M., Miraglia, V., Rizzi, S., Sofianos, D., Cecchini, F., Osório, T. G., Paparella, G., Ramak, R., ... de Asmundis, C. (2022). High-density epicardial mapping in Brugada syndrome: Depolarization and repolarization abnormalities. Heart Rhythm, 19(3), 397-404. https://doi.org/10.1016/j.hrthm.2021.09.032

Pannone, Luigi ; Monaco, Cinzia ; Sorgente, Antonio ; Vergara, Pasquale ; Calburean, Paul-Adrian ; Gauthey, Anaïs ; Bisignani, Antonio ; Kazawa, Shuichiro ; Strazdas, Antanas ; Mojica, Joerelle ; Lipartiti, Felicia ; Al Housari, Maysam ; Miraglia, Vincenzo ; Rizzi, Sergio ; Sofianos, Dimitrios ; Cecchini, Federico ; Osório, Thiago Guimarães ; Paparella, Gaetano ; Ramak, Robbert ; Overeinder, Ingrid ; Bala, Gezim ; Almorad, Alexandre ; Ströker, Erwin ; Pappaert, Gudrun ; Sieira, Juan ; Brugada, Pedro ; La Meir, Mark ; Chierchia, Gian Battista ; de Asmundis, Carlo. / High-density epicardial mapping in Brugada syndrome : Depolarization and repolarization abnormalities. In: Heart Rhythm. 2022 ; Vol. 19, No. 3. pp. 397-404.

@article{56858e6fe6d4488aa309cfd240873bda,

title = "High-density epicardial mapping in Brugada syndrome: Depolarization and repolarization abnormalities",

abstract = "BACKGROUND: The pathogenesis of Brugada syndrome (BrS) and consequently of abnormal electrograms (aEGMs) found in the epicardium of the right ventricular outflow tract (RVOT-EPI) is controversial.OBJECTIVE: The purpose of this study was to analyze aEGM from high-density RVOT-EPI electroanatomic mapping (EAM).METHODS: All patients undergoing RVOT-EPI EAM with the HD-Grid catheter for BrS were retrospectively included. Maps were acquired before and after ajmaline, and all patients had concomitant noninvasive electrocardiographic imaging with annotation of RVOT-EPI latest activation time (RVOTat). High-frequency potentials (HFPs) were defined as ventricular potentials occurring during or after the far-field ventricular EGM showing a local activation time (HFPat). Low-frequency potentials (LFPs) were defined as aEGMs occurring after near-field ventricular activation showing fractionation or delayed components. Their activation time from surface ECG was defined as LFPat.RESULTS: Fifteen consecutive patients were included in the study. At EAM before ajmaline, 7 patients (46.7%) showed LFPs. All patients showed HFPs before and after ajmaline and LFPs after ajmaline. Mean HFPat (134.4 vs 65.3 ms, P <.001), mean LFPat (224.6 vs 113.6 ms, P <.001), and mean RVOTat (124.8 vs 55.9 ms, P <.001) increased after ajmaline. RVOTat correlated with HFPat before (ρ = 0.76) and after ajmaline (ρ = 0.82), while RVOTat was shorter than LFPat before (P <.001) and after ajmaline (P <.001). BrS patients with history of aborted sudden cardiac death had longer aEGMs after ajmaline.CONCLUSION: Two different types of aEGMs are described from BrS high-density epicardial mapping. This might correlate with depolarization and repolarization abnormalities.",

keywords = "Brugada syndrome, Electrocardiographic imaging, High-density mapping, Sudden cardiac death, Ventricular tachycardia ablation",

author = "Luigi Pannone and Cinzia Monaco and Antonio Sorgente and Pasquale Vergara and Paul-Adrian Calburean and Ana{\"i}s Gauthey and Antonio Bisignani and Shuichiro Kazawa and Antanas Strazdas and Joerelle Mojica and Felicia Lipartiti and {Al Housari}, Maysam and Vincenzo Miraglia and Sergio Rizzi and Dimitrios Sofianos and Federico Cecchini and Os{\'o}rio, {Thiago Guimar{\~a}es} and Gaetano Paparella and Robbert Ramak and Ingrid Overeinder and Gezim Bala and Alexandre Almorad and Erwin Str{\"o}ker and Gudrun Pappaert and Juan Sieira and Pedro Brugada and {La Meir}, Mark and Chierchia, {Gian Battista} and {de Asmundis}, Carlo",

year = "2022",

month = mar,

doi = "10.1016/j.hrthm.2021.09.032",

language = "English",

volume = "19",

pages = "397--404",

journal = "Heart Rhythm",

issn = "1547-5271",

publisher = "Elsevier",

number = "3",

}

Pannone, L , Monaco, C , Sorgente, A , Vergara, P, Calburean, P-A, Gauthey, A, Bisignani, A, Kazawa, S, Strazdas, A, Mojica, J, Lipartiti, F, Al Housari, M, Miraglia, V, Rizzi, S, Sofianos, D, Cecchini, F, Osório, TG , Paparella, G, Ramak, R, Overeinder, I , Bala, G , Almorad, A , Ströker, E , Pappaert, G , Sieira, J , Brugada, P , La Meir, M , Chierchia, GB & de Asmundis, C 2022, 'High-density epicardial mapping in Brugada syndrome: Depolarization and repolarization abnormalities', Heart Rhythm, vol. 19, no. 3, pp. 397-404. https://doi.org/10.1016/j.hrthm.2021.09.032

High-density epicardial mapping in Brugada syndrome : Depolarization and repolarization abnormalities. / Pannone, Luigi ; Monaco, Cinzia ; Sorgente, Antonio ; Vergara, Pasquale; Calburean, Paul-Adrian; Gauthey, Anaïs; Bisignani, Antonio; Kazawa, Shuichiro; Strazdas, Antanas; Mojica, Joerelle; Lipartiti, Felicia; Al Housari, Maysam; Miraglia, Vincenzo; Rizzi, Sergio; Sofianos, Dimitrios; Cecchini, Federico; Osório, Thiago Guimarães ; Paparella, Gaetano; Ramak, Robbert; Overeinder, Ingrid ; Bala, Gezim ; Almorad, Alexandre ; Ströker, Erwin ; Pappaert, Gudrun ; Sieira, Juan ; Brugada, Pedro ; La Meir, Mark ; Chierchia, Gian Battista ; de Asmundis, Carlo.

In: Heart Rhythm, Vol. 19, No. 3, 03.2022, p. 397-404.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - High-density epicardial mapping in Brugada syndrome

T2 - Depolarization and repolarization abnormalities

AU - Pannone, Luigi

AU - Monaco, Cinzia

AU - Sorgente, Antonio

AU - Vergara, Pasquale

AU - Calburean, Paul-Adrian

AU - Gauthey, Anaïs

AU - Bisignani, Antonio

AU - Kazawa, Shuichiro

AU - Strazdas, Antanas

AU - Mojica, Joerelle

AU - Lipartiti, Felicia

AU - Al Housari, Maysam

AU - Miraglia, Vincenzo

AU - Rizzi, Sergio

AU - Sofianos, Dimitrios

AU - Cecchini, Federico

AU - Osório, Thiago Guimarães

AU - Paparella, Gaetano

AU - Ramak, Robbert

AU - Overeinder, Ingrid

AU - Bala, Gezim

AU - Almorad, Alexandre

AU - Ströker, Erwin

AU - Pappaert, Gudrun

AU - Sieira, Juan

AU - Brugada, Pedro

AU - La Meir, Mark

AU - Chierchia, Gian Battista

AU - de Asmundis, Carlo

PY - 2022/3

Y1 - 2022/3

N2 - BACKGROUND: The pathogenesis of Brugada syndrome (BrS) and consequently of abnormal electrograms (aEGMs) found in the epicardium of the right ventricular outflow tract (RVOT-EPI) is controversial.OBJECTIVE: The purpose of this study was to analyze aEGM from high-density RVOT-EPI electroanatomic mapping (EAM).METHODS: All patients undergoing RVOT-EPI EAM with the HD-Grid catheter for BrS were retrospectively included. Maps were acquired before and after ajmaline, and all patients had concomitant noninvasive electrocardiographic imaging with annotation of RVOT-EPI latest activation time (RVOTat). High-frequency potentials (HFPs) were defined as ventricular potentials occurring during or after the far-field ventricular EGM showing a local activation time (HFPat). Low-frequency potentials (LFPs) were defined as aEGMs occurring after near-field ventricular activation showing fractionation or delayed components. Their activation time from surface ECG was defined as LFPat.RESULTS: Fifteen consecutive patients were included in the study. At EAM before ajmaline, 7 patients (46.7%) showed LFPs. All patients showed HFPs before and after ajmaline and LFPs after ajmaline. Mean HFPat (134.4 vs 65.3 ms, P <.001), mean LFPat (224.6 vs 113.6 ms, P <.001), and mean RVOTat (124.8 vs 55.9 ms, P <.001) increased after ajmaline. RVOTat correlated with HFPat before (ρ = 0.76) and after ajmaline (ρ = 0.82), while RVOTat was shorter than LFPat before (P <.001) and after ajmaline (P <.001). BrS patients with history of aborted sudden cardiac death had longer aEGMs after ajmaline.CONCLUSION: Two different types of aEGMs are described from BrS high-density epicardial mapping. This might correlate with depolarization and repolarization abnormalities.

AB - BACKGROUND: The pathogenesis of Brugada syndrome (BrS) and consequently of abnormal electrograms (aEGMs) found in the epicardium of the right ventricular outflow tract (RVOT-EPI) is controversial.OBJECTIVE: The purpose of this study was to analyze aEGM from high-density RVOT-EPI electroanatomic mapping (EAM).METHODS: All patients undergoing RVOT-EPI EAM with the HD-Grid catheter for BrS were retrospectively included. Maps were acquired before and after ajmaline, and all patients had concomitant noninvasive electrocardiographic imaging with annotation of RVOT-EPI latest activation time (RVOTat). High-frequency potentials (HFPs) were defined as ventricular potentials occurring during or after the far-field ventricular EGM showing a local activation time (HFPat). Low-frequency potentials (LFPs) were defined as aEGMs occurring after near-field ventricular activation showing fractionation or delayed components. Their activation time from surface ECG was defined as LFPat.RESULTS: Fifteen consecutive patients were included in the study. At EAM before ajmaline, 7 patients (46.7%) showed LFPs. All patients showed HFPs before and after ajmaline and LFPs after ajmaline. Mean HFPat (134.4 vs 65.3 ms, P <.001), mean LFPat (224.6 vs 113.6 ms, P <.001), and mean RVOTat (124.8 vs 55.9 ms, P <.001) increased after ajmaline. RVOTat correlated with HFPat before (ρ = 0.76) and after ajmaline (ρ = 0.82), while RVOTat was shorter than LFPat before (P <.001) and after ajmaline (P <.001). BrS patients with history of aborted sudden cardiac death had longer aEGMs after ajmaline.CONCLUSION: Two different types of aEGMs are described from BrS high-density epicardial mapping. This might correlate with depolarization and repolarization abnormalities.

KW - Brugada syndrome

KW - Electrocardiographic imaging

KW - High-density mapping

KW - Sudden cardiac death

KW - Ventricular tachycardia ablation

UR - http://www.scopus.com/inward/record.url?scp=85119112055&partnerID=8YFLogxK

U2 - 10.1016/j.hrthm.2021.09.032

DO - 10.1016/j.hrthm.2021.09.032

M3 - Article

C2 - 34601129

VL - 19

SP - 397

EP - 404

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

IS - 3

ER -

High-density epicardial mapping in Brugada syndrome: Depolarization and repolarization abnormalities

Abstract

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Keywords

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