Right Ventricular Outflow Tract Electroanatomical Abnormalities Predict Ventricular Fibrillation Inducibility in Brugada Syndrome
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Electroanatomical mapping has demonstrated abnormal bipolar electrograms at the anterior aspect of the right ventricular outflow tract (RVOT) epicardium along with histopathologic evidence of fibrosis in patients with Brugada syndrome (BrS).1,2 These epicardial abnormalities are believed to serve as the electric substrate for ventricular fibrillation (VF) initiation and maintenance in BrS.1,2 We have recently demonstrated that patients with BrS display wide areas of endocardial unipolar voltage abnormalities that possibly reflect epicardial structural abnormalities at the free wall of the RVOT.3 We hypothesized that electroanatomical abnormalities detected by high-density endocardial unipolar voltage mapping at the RVOT predict VF inducibility during programmed ventricular stimulation (PVS).
The study population consisted of 17 asymptomatic probands (15 males, 37.3±10.8 years) with spontaneous type 1 BrS ECG pattern referred for risk stratification with PVS. A comprehensive evaluation including late gadolinium enhancement cardiac magnetic resonance imaging ruled out structural heart disease in all patients. The study was approved by the Hospital Ethics Committee and written informed consent was obtained from all patients.
High-density electroanatomical mapping of the RVOT during sinus rhythm was performed as described previously (Methods in the Data Supplement).3 In brief, a minimum of 800 points were sampled to …