Epicardial activation-recovery intervals in the right ventricular outflow tract were paradoxically abbreviated during augmented ST segment elevation, supporting a heterogenous repolarization response.
Case Report (n=1)
No
Does heterogenous response of repolarization across the ventricular wall in the RVOT explain accentuation of ST segment elevation in Brugada syndrome?
In a patient with Brugada-like ECG, epicardial ARI in the RVOT paradoxically abbreviated during augmented ST segment elevation, supporting the hypothesis of heterogeneous transmural repolarization.
We report the case of a 53-year-old Japanese man with a typical Brugada-like ECG in whom epicardial and endocardial activation-recovery intervals (ARI) in the right ventricular outflow tract (RVOT) were simultaneously measured by recording unipolar electrograms from the Pathfinder catheter introduced in the great cardiac vein as well as from the multielectrode basket catheter deployed in the RVOT. Epicardial ARI in the RVOT was abbreviated paradoxically at the beat of augmented ST segment elevation in lead V2 after a long pause or after pilsicainide injection. Endocardial ARI in the RVOT and epicardial ARI in the left ventricle were prolonged or were not changed. Our data support the hypothesis that heterogenous response of repolarization across the ventricular wall in the RVOT is responsible for accentuation of ST segment elevation in the right precordial leads.
Shimizu et al. (Sat,) conducted a case report in Brugada-like ECG (n=1). Simultaneous measurement of epicardial and endocardial ARI and pilsicainide injection was evaluated on Activation-recovery intervals (ARI) in the right ventricular outflow tract. Epicardial activation-recovery intervals in the right ventricular outflow tract were paradoxically abbreviated during augmented ST segment elevation, supporting a heterogenous repolarization response.
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