Epicardial radiofrequency ablation in Brugada syndrome patients significantly reduced QRS duration (151 vs 102 ms, P<0.001) and normalized temporo-spatial depolarization and repolarization forces.
Observational (n=90)
Does epicardial radiofrequency ablation normalize ECG depolarization and repolarization parameters in high-risk patients with Brugada syndrome?
Epicardial ablation of the arrhythmogenic substrate in Brugada syndrome normalizes both standard ECG intervals and 3D temporo-spatial depolarization/repolarization forces.
Absolute Event Rate: 102% vs 151%
p-value: p=<0.001
Abstract Aims In Brugada syndrome (BrS), with spontaneous or ajmaline-induced coved ST elevation, epicardial electro-anatomic potential duration maps (epi-PDMs) were detected on a right ventricle (RV) outflow tract (RVOT), an arrhythmogenic substrate area (AS area), abolished by epicardial-radiofrequency ablation (EPI-AS-RFA). Novel CineECG, projecting 12-lead electrocardiogram (ECG) waveforms on a 3D heart model, previously localized depolarization forces in RV/RVOT in BrS patients. We evaluate 12-lead ECG and CineECG depolarization/repolarization changes in spontaneous type-1 BrS patients before/after EPI-AS-RFA, compared with normal controls. Methods and results In 30 high-risk BrS patients (93% males, age 37 + 9 years), 12-lead ECGs and epi-PDMs were obtained at baseline, early after EPI-AS-RFA, and late follow-up (FU) (2.7–16.1 months). CineECG estimates temporo-spatial localization during depolarization (Early-QRS and Terminal-QRS) and repolarization (ST-Tpeak, Tpeak-Tend). Differences within BrS patients (baseline vs. early after EPI-AS-RFA vs. late FU) were analysed by Wilcoxon signed-rank test, while differences between BrS patients and 60 age–sex-matched normal controls were analysed by the Mann–Whitney test. In BrS patients, baseline QRS and QTc durations were longer and normalized after EPI-AS-ATC (151 ± 15 vs. 102 ± 13 ms, P 0.001; 454 ± 40 vs. 421 ± 27 ms, P 0.000). Baseline QRS amplitude was lower and increased at late FU (0.63 ± 0.26 vs. 0.84 ± 13 ms, P 0.000), while Terminal-QRS amplitude decreased (0.24 ± 0.07 vs. 0.08 ± 0.03 ms, P 0.000). At baseline, CineECG depolarization/repolarization wavefront prevalently localized in RV/RVOT (Terminal-QRS, 57%; ST-Tpeak, 100%; and Tpeak-Tend, 61%), congruent with the AS area on epi-PDM. Early after EPI-AS-RFA, RV/RVOT localization during depolarization disappeared, as Terminal-QRS prevalently localized in the left ventricle (LV, 76%), while repolarization still localized on RV/RVOT ST-Tpeak (44%) and Tpeak-Tend (98%). At late FU, depolarization/repolarization forces prevalently localized in the LV (Terminal-QRS, 94%; ST-Tpeak, 63%; Tpeak-Tend, 86%), like normal controls. Conclusion CineECG and 12-lead ECG showed a complex temporo-spatial perturbation of both depolarization and repolarization in BrS patients, prevalently localized in RV/RVOT, progressively normalizing after epicardial ablation.
Locati et al. (Tue,) conducted a observational in Brugada syndrome (n=90). Epicardial-radiofrequency ablation (EPI-AS-RFA) vs. Baseline and normal controls was evaluated on QRS duration (ms) (p=<0.001). Epicardial radiofrequency ablation in Brugada syndrome patients significantly reduced QRS duration (151 vs 102 ms, P<0.001) and normalized temporo-spatial depolarization and repolarization forces.
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