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Local Left Ventricular Epicardial J Waves and Late Potentials in Brugada Syndrome Patients with Inferolateral Early Repolarization Pattern

Background: Brugada syndrome (BrS) is characterized by J-point or ST-segment elevation on electrocardiograms (ECGs) and increased risk of ventricular fibrillation (VF). In BrS, epicardial depolarization abnormality with delayed potential on the right ventricular outflow tract is reportedly the predo...

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Autores principales: Nagase, Satoshi, Tanaka, Masamichi, Morita, Hiroshi, Nakagawa, Koji, Wada, Tadashi, Murakami, Masato, Nishii, Nobuhiro, Nakamura, Kazufumi, Ito, Hiroshi, Ohe, Tohru, Kusano, Kengo F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5266732/
https://www.ncbi.nlm.nih.gov/pubmed/28184198
http://dx.doi.org/10.3389/fphys.2017.00014
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author Nagase, Satoshi
Tanaka, Masamichi
Morita, Hiroshi
Nakagawa, Koji
Wada, Tadashi
Murakami, Masato
Nishii, Nobuhiro
Nakamura, Kazufumi
Ito, Hiroshi
Ohe, Tohru
Kusano, Kengo F.
author_facet Nagase, Satoshi
Tanaka, Masamichi
Morita, Hiroshi
Nakagawa, Koji
Wada, Tadashi
Murakami, Masato
Nishii, Nobuhiro
Nakamura, Kazufumi
Ito, Hiroshi
Ohe, Tohru
Kusano, Kengo F.
author_sort Nagase, Satoshi
collection PubMed
description Background: Brugada syndrome (BrS) is characterized by J-point or ST-segment elevation on electrocardiograms (ECGs) and increased risk of ventricular fibrillation (VF). In BrS, epicardial depolarization abnormality with delayed potential on the right ventricular outflow tract is reportedly the predominant mechanism underlying VF. Yet VF occurrence is also associated with early repolarization (ER) pattern in the inferolateral ECG leads, which may represent the inferior and/or left lateral ventricular myocardium. The aim of this study was to examine epicardial electrograms recorded directly at the left ventricle (LV) in BrS patients after VF episodes. Methods: In 12 BrS patients who had experienced VF episodes and 17 control subjects, a multipolar catheter was introduced into the left lateral coronary vein for unipolar and bipolar electrogram recordings at the LV epicardium. Both inferior and lateral ER patterns on ECG were observed in three BrS patients and six control subjects. Results: In the epicardium, prominent J waves were detected using unipolar recording, and potentials after the QRS complex were detected using bipolar recording in three of the 12 BrS patients. These three patients also showed both inferior and lateral ER patterns on ECG. Neither prominent J waves nor potentials after the QRS complex were recorded at the endocardium of the LV in any of these three patients; nor were they seen at the epicardium in any of the control subjects. These features were accentuated on pilsicainide administration (n = 2) but diminished on constant atrial pacing (n = 3) and isoproterenol administration (n = 1). The J waves observed through unipolar recording coincided with the potentials after QRS complex observed through bipolar recording and with the inferolateral ER patterns on ECG. Conclusions: We recorded prominent J waves in unipolar electrogram and potentials after QRS complex in bipolar electrogram at the LV epicardium in BrS patients with global ER pattern. The prominent J waves coincided with the potentials after QRS complex and the inferolateral ER pattern on ECG. The characteristics of the inferolateral ER pattern on ECG in these patients primarily represent depolarization feature.
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spelling pubmed-52667322017-02-09 Local Left Ventricular Epicardial J Waves and Late Potentials in Brugada Syndrome Patients with Inferolateral Early Repolarization Pattern Nagase, Satoshi Tanaka, Masamichi Morita, Hiroshi Nakagawa, Koji Wada, Tadashi Murakami, Masato Nishii, Nobuhiro Nakamura, Kazufumi Ito, Hiroshi Ohe, Tohru Kusano, Kengo F. Front Physiol Physiology Background: Brugada syndrome (BrS) is characterized by J-point or ST-segment elevation on electrocardiograms (ECGs) and increased risk of ventricular fibrillation (VF). In BrS, epicardial depolarization abnormality with delayed potential on the right ventricular outflow tract is reportedly the predominant mechanism underlying VF. Yet VF occurrence is also associated with early repolarization (ER) pattern in the inferolateral ECG leads, which may represent the inferior and/or left lateral ventricular myocardium. The aim of this study was to examine epicardial electrograms recorded directly at the left ventricle (LV) in BrS patients after VF episodes. Methods: In 12 BrS patients who had experienced VF episodes and 17 control subjects, a multipolar catheter was introduced into the left lateral coronary vein for unipolar and bipolar electrogram recordings at the LV epicardium. Both inferior and lateral ER patterns on ECG were observed in three BrS patients and six control subjects. Results: In the epicardium, prominent J waves were detected using unipolar recording, and potentials after the QRS complex were detected using bipolar recording in three of the 12 BrS patients. These three patients also showed both inferior and lateral ER patterns on ECG. Neither prominent J waves nor potentials after the QRS complex were recorded at the endocardium of the LV in any of these three patients; nor were they seen at the epicardium in any of the control subjects. These features were accentuated on pilsicainide administration (n = 2) but diminished on constant atrial pacing (n = 3) and isoproterenol administration (n = 1). The J waves observed through unipolar recording coincided with the potentials after QRS complex observed through bipolar recording and with the inferolateral ER patterns on ECG. Conclusions: We recorded prominent J waves in unipolar electrogram and potentials after QRS complex in bipolar electrogram at the LV epicardium in BrS patients with global ER pattern. The prominent J waves coincided with the potentials after QRS complex and the inferolateral ER pattern on ECG. The characteristics of the inferolateral ER pattern on ECG in these patients primarily represent depolarization feature. Frontiers Media S.A. 2017-01-26 /pmc/articles/PMC5266732/ /pubmed/28184198 http://dx.doi.org/10.3389/fphys.2017.00014 Text en Copyright © 2017 Nagase, Tanaka, Morita, Nakagawa, Wada, Murakami, Nishii, Nakamura, Ito, Ohe and Kusano. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Physiology
Nagase, Satoshi
Tanaka, Masamichi
Morita, Hiroshi
Nakagawa, Koji
Wada, Tadashi
Murakami, Masato
Nishii, Nobuhiro
Nakamura, Kazufumi
Ito, Hiroshi
Ohe, Tohru
Kusano, Kengo F.
Local Left Ventricular Epicardial J Waves and Late Potentials in Brugada Syndrome Patients with Inferolateral Early Repolarization Pattern
title Local Left Ventricular Epicardial J Waves and Late Potentials in Brugada Syndrome Patients with Inferolateral Early Repolarization Pattern
title_full Local Left Ventricular Epicardial J Waves and Late Potentials in Brugada Syndrome Patients with Inferolateral Early Repolarization Pattern
title_fullStr Local Left Ventricular Epicardial J Waves and Late Potentials in Brugada Syndrome Patients with Inferolateral Early Repolarization Pattern
title_full_unstemmed Local Left Ventricular Epicardial J Waves and Late Potentials in Brugada Syndrome Patients with Inferolateral Early Repolarization Pattern
title_short Local Left Ventricular Epicardial J Waves and Late Potentials in Brugada Syndrome Patients with Inferolateral Early Repolarization Pattern
title_sort local left ventricular epicardial j waves and late potentials in brugada syndrome patients with inferolateral early repolarization pattern
topic Physiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5266732/
https://www.ncbi.nlm.nih.gov/pubmed/28184198
http://dx.doi.org/10.3389/fphys.2017.00014
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