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January 26, 2017Frontiers in PhysiologyOpen Access

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

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Why the study?

Are prominent J waves and late potentials present at the left ventricular epicardium in Brugada syndrome patients with inferolateral early repolarization patterns?

Population

12 patients with Brugada syndrome and 17 control subjects.

Comparison

Electrophysiological study with multipolar… vs Control subjects without Brugada syndrome…

Design

Case-control

Key result

Prominent J waves and potentials after the QRS complex were recorded at the left ventricular epicardium in 3 of 12 Brugada syndrome patients with global early repolarization patterns, compared to 0 of 17 control subjects.

Authors

SNSatoshi NagaseMTMasamichi TanakaHMHiroshi Morita

Discussion

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Overview

Suggests inferolateral ER reflects LV epicardial depolarization abnormalities in Brugada syndrome; hypothesis-generating and should not yet change practice.

Study Design

Type

Observational (n=29)

Multicenter

No

Structured PICO

Are prominent J waves and late potentials present at the left ventricular epicardium in Brugada syndrome patients with inferolateral early repolarization patterns?

P
Population
12 patients with Brugada syndrome (mean age 43 ± 11 years, 100% male, all with >1 episode of ventricular fibrillation) and 17 control subjects (mean age 48 ± 19 years, 76% male).
I
Intervention
Electrophysiological study with multipolar catheter mapping of the left ventricular epicardium via the lateral coronary vein, including unipolar and bipolar electrogram recordings.
C
Comparator
Control subjects without Brugada syndrome undergoing the same electrophysiological mapping.
O
Outcome
Presence and characteristics of prominent J waves in unipolar electrograms and potentials after QRS complex in bipolar electrograms at the left ventricular epicardium.surrogate

Main Result

Absolute Event Rate: 25% vs 0%

This study demonstrates that inferolateral early repolarization patterns on ECG in Brugada syndrome patients correspond to local depolarization abnormalities (prominent J waves and late potentials) at the left ventricular epicardium.

Limitations

  • Small number of Brugada syndrome patients, especially those with a global early repolarization pattern
  • Unipolar recordings are influenced by far-field electrical activity
  • Epicardial recording was not performed on the anterior and inferior left ventricle
  • Small and heterogeneous control group that was not matched with the Brugada syndrome patients
  • Left ventricular endocardial mapping was not performed in the majority of patients due to ethical concerns
  • Programmed epicardial pacing on the left ventricle was not performed
  • Small number of BrS patients, especially those with a global ER pattern
  • Unipolar recordings are inevitably influenced by far-field electrical activity
  • Electrograms were only recorded in the area through which the major epicardial vein in the LV runs
  • Small and highly heterogeneous control group not matched with BrS patients
  • LV endocardial mapping and programmed epicardial pacing on the LV were not performed in the majority of patients

Cite This Study

Nagase et al. (2017) conducted an observational in Brugada syndrome (n=29). Left ventricular epicardial electrogram recording vs. Control subjects was evaluated on Presence of prominent J waves and potentials after the QRS complex at the left ventricular epicardium. Prominent J waves and potentials after the QRS complex were recorded at the left ventricular epicardium in 3 of 12 Brugada syndrome patients with global early repolarization patterns, compared to 0 of 17 control subjects.

synapsesocial.com/papers/6a0cfb7332f3c40b5ccbb046https://doi.org/10.3389/fphys.2017.00014
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