Key result
Non-invasive cardiac mapping with dST-Tiso during ajmaline testing identifies RVOT conduction blocks.
Why the study?
The authors sought to stratify sudden cardiac death risk in Brugada syndrome during ajmaline testing by combining the dST-Tiso interval with non-invasive electrocardiographic imaging technology.
Does the combination of dST-Tiso interval and electrocardiographic imaging during ajmaline testing identify pathological epicardial substrate in a patient with Brugada Syndrome?
Case Report (n=1)
Does the combination of dST-Tiso interval and electrocardiographic imaging during ajmaline testing identify pathological epicardial substrate in a patient with Brugada Syndrome?
The combination of the dST-Tiso interval and non-invasive electrocardiographic imaging during ajmaline testing may help identify arrhythmogenic epicardial substrates and stratify sudden cardiac death risk in Brugada Syndrome.
Hypothesis-generating for non-invasive epicardial substrate mapping in Brugada syndrome; prospective validation needed before clinical adoption.
Introduction: It has recently been shown that electrocardiographic imaging (ECGi) can be employed in individuals undergoing an ajmaline test who have Brugada Syndrome (BrS), to evaluate the extent of substrate-involved arrhythmia in the right ventricular overflow tract (RVOT). For the first time, we stratify the risk of sudden cardiac death (SCD) in BrS during ajmaline testing using the dST-Tiso interval (a robust predictor of the inducibility of ventricular arrhythmias (VAs) in the presence of drug-induced BrS type-1 pattern) in combination with ECGi technology. Case presentation: We studied a 48-year-old man with BrS ECG type-2 pattern and presence of J-wave without a family history of SCD but with a previous syncope. Transthoracic echocardiography and cardiac magnetic resonance imaging were performed, showing normal results. The ECG was performed to assess the novel ECG marker "dST-Tiso interval." The 3D epicardial mapping of the RVOT surface was performed with the support of a non-contact cardiac mapping system in sinus rhythm during ajmaline infusion. The examination of the propagation map unveiled the presence of multiple conduction blocks in this pathologic epicardial region, and the conduction blocks were identified within the central part and/or near the boundary separating the normal and slow conduction areas. Conclusion: The dST-Tiso interval, which lies between the onset and termination of the coved ST-segment elevation and serves as a robust predictor of VA inducibility in cases of drug-induced BrS type-1 pattern, was utilized in conjunction with ECGi technology (employed for the non-invasive confirmation and identification of the pathological substrate area). This combined approach was applied to stratify the risk of SCD in BrS during ajmaline testing, alongside clinical scores.
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Iacopino et al. (2024) conducted a case report in Brugada Syndrome (n=1). Electrocardiographic imaging (ECGi) and dST-Tiso interval assessment during ajmaline testing was evaluated on Identification of severity of epicardial substrate and risk stratification of sudden cardiac death. Non-invasive cardiac activation mapping combined with the dST-Tiso interval during ajmaline testing successfully identified multiple conduction blocks in the right ventricular overflow tract.
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