New electromechanical substrate abnormalities in high-risk patients with Brugada syndrome
New electromechanical substrate abnormalities in high-risk patients with Brugada syndrome
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DOI：
10.1016/j.hrthm.2019.11.019
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发表时间：
2020-04-01
期刊：
影响因子：
5.5
通讯作者：
Santinelli, Vincenzo
中科院分区：
文献类型：
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作者：
Pappone, Carlo;Mecarocci, Valerio;Santinelli, Vincenzo
背景 从未系统地探讨过 Brugada 综合征 (BrS) 的典型心电图模式与机电异常之间的关系。 目的 本研究的目的是描述 BrS 患者的机电基质特征，并评估电气和机械异常之间的关系。 方法 我们入组了 50 名连续患有 BrS 的高危患者（平均年龄 42 +/- 7.2 岁），均使用植入式心脏复律除颤器。植入用于室性快速性心律失常（室性心动过速/心室颤动 [VT/VF]）的一级或二级预防，进行基质标测和消融。在阿马林给药（5 分钟内 1 mg/kg）前后，患者接受了 3D 室壁运动/变形量化和电解剖测绘的 3 维 (3D) 超声心动图检查；将 3D 机械变化与 50 名年龄和性别匹配的对照进行比较。还评估了基质消融对机电异常的影响。 结果 在所有患者中，阿马林给药诱导 Brugada 1 型模式，电基质显着增加 (P < .001)，特别是在既往自发性 VT/VF 的患者中 (P = .007)。 Brugada 模式的诱导与右心室 (RV) 射血分数降低 (P < .001) 和 3D RV 机械功能恶化 (P < .001) 相关，特别是在 RV 流出道的前游离壁中，而对照组没有变化。 RV 电气和机械异常高度相关 (r = 0.728，P < .001)。通过多变量分析，只有右心室功能障碍的面积是自发性 VT/VF 的独立预测因子（比值比 1.480；95% 置信区间 1.159-1.889；P = .002）。尽管重新使用阿马林，但基底消融消除了 BrS 心电图模式和机械异常。结论 BrS 是一种影响 RV 的机电疾病。典型的 BrS 模式反映了广泛的 RV 心律失常基质，导致持续的 RV 机械异常。基底消融消除了 Brugada 模式和机械异常。
BACKGROUND The relationship between the typical electrocardiographic pattern and electromechanical abnormalities has never been systematically explored in Brugada syndrome (BrS).OBJECTIVES The aims of this study were to characterize the elec- tromechanical substrate in patients with BrS and to evaluate the relationship between electrical and mechanical abnormalities.METHODS We enrolled 50 consecutive high-risk patients with BrS (mean age 42 +/- 7.2 years), with implantable cardioverter-defibrillator implantation for primary or secondary prevention of ventricular tachyarrhythmias (ventricular tachycardia/ventricular fibrillation [VT/VF]), undergoing substrate mapping and ablation. Patients underwent 3-dimensional (3D) echocardiography with 3D wall motion/deformation quantification and electroanatomic mapping before and after ajmaline administration (1 mg/kg in 5 minutes); 3D mechanical changes were compared with 50 age- and sex-matched controls. The effect of substrate ablation on electromechanical abnormalities was also assessed.RESULTS In all patients, ajmaline administration induced Brugada type 1 pattern, with a significant increase in the electrical substrate (P < .001), particularly in patients with previous spontaneous VT/VF (P = .007). Induction of Brugada pattern was associated with lowering of right ventricular (RV) ejection fraction (P < .001) and worsening of 3D RV mechanical function (P < .001), particularly in the anterior free wall of the RV outflow tract, without changes in controls. RV electrical and mechanical abnormalities were highly correlated (r = 0.728, P < .001). By multivariate analysis, only the area of RV dysfunction was an independent predictor of spontaneous VT/VF (odds ratio 1.480; 95% confidence interval 1.159-1.889; P = .002). Substrate ablation abolished both BrS-electrocardiographic pattern and mechanical abnormalities, despite ajmaline rechallenge.CONCLUSION BrS is an electromechanical disease affecting the RV. The typical BrS pattern reflects an extensive RV arrhythmic substrate, driving consistent RV mechanical abnormalities. Substrate ablation abolished both Brugada pattern and mechanical abnormalities.