Endocardial Approach for Substrate Ablation in Brugada Syndrome: Epicardial, Endocardial or Transmural Substrate?

Autores
Tauber, Pablo E.; Mansilla, Virginia; Brugada, Pedro; Sanchez, Sara Serafina del V.; Honore, Stella Maris; Elizari, Marcelo; Chain Molina, Sergio; Albano, Félix A.; Corbalán, Ricardo R.; Figueroa Castellanos, Federico; Alzugaray, Damián
Año de publicación
2018
Idioma
inglés
Tipo de recurso
artículo
Estado
versión publicada
Descripción
Background: Radiofrequency ablation (RFA) in Brugada syndrome (BrS) has been performed both endocardially and epicardially. The substrate in BrS is thus unclear.Objectives: To investigate the functional endocardial substrate and its correlation with clinical, electrophysiological and ECG findings in order to guide an endocardial ablation.Methods: Thirteen patients (38.7±12.3 years old) with spontaneous type 1 ECG BrS pattern, inducible VF with programmed ventricular stimulation (PVS) and syncope without prodromes were enrolled. Before to endocardial mapping the patients underwent flecainide testing with the purpose of measuring the greatest ST-segment elevation for to be correlated with the size and location of substrate in the electro-anatomic map. Patients underwent endocardial bipolar and electro-anatomic mapping with the purpose of identify areas of abnormal electrograms (EGMs) as target for RFA and determine the location and size of the substrate.Results: When the greatest ST-segment elevation was in the 3rd intercostal space (ICS), the substrate was located upper in the longitudinal plane of the right ventricular outflow tract (RVOT) and a greatest ST-segment elevation in 4th ICS correspond with a location of substrate in lower region of longitudinal plane of RVOT. A QRS complex widening on its initial and final part, with prolonged transmural and regional depolarization time of RVOT corresponded to the substrate locateded in the anterior-lateral region of RVOT. A QRS complex widening rightwards and only prolonged transmural depolarization time corresponded with a substrate located in the anterior, anterior-septal or septal region of RVOT. RFA of endocardial substrate suppressed the inducibility and ECG BrS pattern during 34.7±15.5 months. After RFA, flecainide testing confirmed elimination of the ECG BrS pattern. Endocardial biopsy showed a correlation between functional and ultrastructural alterations in two patients.Keywords: Brugada syndrome; Radiofrequency catheter ablation; Electrocardiography; Mapping; Biopsy.Conclusion: Endocardial RFA can eliminate the BrS phenotype and inducibility during PVS.
Fil: Tauber, Pablo E.. Centro Modelo del Corazón; Argentina. Gobierno de Tucumán. Ministerio de Salud. Hospital Centro de Salud "Zenón J. Santillán"; Argentina
Fil: Mansilla, Virginia. Centro Modelo del Corazón; Argentina
Fil: Brugada, Pedro. Free University of Brussels. Cardiovascular Division. Cardiovascular Institute; Bélgica
Fil: Sanchez, Sara Serafina del V.. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto Superior de Investigaciones Biológicas. Universidad Nacional de Tucumán. Instituto Superior de Investigaciones Biológicas; Argentina. Universidad Nacional de Tucumán. Facultad de Bioquímica, Química y Farmacia; Argentina
Fil: Honore, Stella Maris. Universidad Nacional de Tucumán. Facultad de Bioquímica, Química y Farmacia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto Superior de Investigaciones Biológicas. Universidad Nacional de Tucumán. Instituto Superior de Investigaciones Biológicas; Argentina
Fil: Elizari, Marcelo. Academia Nacional de Medicina de Buenos Aires; Argentina
Fil: Chain Molina, Sergio. Centro Modelo del Corazón; Argentina
Fil: Albano, Félix A.. Gobierno de Tucumán. Ministerio de Salud. Hospital Centro de Salud "Zenón J. Santillán"; Argentina
Fil: Corbalán, Ricardo R.. Centro Modelo del Corazón; Argentina
Fil: Figueroa Castellanos, Federico. Clínica Mayo; Argentina
Fil: Alzugaray, Damián. Abbott; Argentina
Materia
BRUGADA SYNDROME
ULTRASTRUCTURAL ALTERATIONS
ELECTROCARDIOGRAPHY
MAPPING
RADIOFREQUENCY CATHETER ABLATION
BIOPSY
Nivel de accesibilidad
acceso abierto
Condiciones de uso
https://creativecommons.org/licenses/by/2.5/ar/
Repositorio
CONICET Digital (CONICET)
Institución
Consejo Nacional de Investigaciones Científicas y Técnicas
OAI Identificador
oai:ri.conicet.gov.ar:11336/101940
Acceder
id CONICETDig_a18a467899ec35dd779f8bb248d7412e
oai_identifier_str oai:ri.conicet.gov.ar:11336/101940
network_acronym_str CONICETDig
repository_id_str 3498
network_name_str CONICET Digital (CONICET)
spelling Endocardial Approach for Substrate Ablation in Brugada Syndrome: Epicardial, Endocardial or Transmural Substrate?Tauber, Pablo E.Mansilla, VirginiaBrugada, PedroSanchez, Sara Serafina del V.Honore, Stella MarisElizari, MarceloChain Molina, SergioAlbano, Félix A.Corbalán, Ricardo R.Figueroa Castellanos, FedericoAlzugaray, DamiánBRUGADA SYNDROMEULTRASTRUCTURAL ALTERATIONSELECTROCARDIOGRAPHYMAPPINGRADIOFREQUENCY CATHETER ABLATIONBIOPSYhttps://purl.org/becyt/ford/1.6https://purl.org/becyt/ford/1Background: Radiofrequency ablation (RFA) in Brugada syndrome (BrS) has been performed both endocardially and epicardially. The substrate in BrS is thus unclear.Objectives: To investigate the functional endocardial substrate and its correlation with clinical, electrophysiological and ECG findings in order to guide an endocardial ablation.Methods: Thirteen patients (38.7±12.3 years old) with spontaneous type 1 ECG BrS pattern, inducible VF with programmed ventricular stimulation (PVS) and syncope without prodromes were enrolled. Before to endocardial mapping the patients underwent flecainide testing with the purpose of measuring the greatest ST-segment elevation for to be correlated with the size and location of substrate in the electro-anatomic map. Patients underwent endocardial bipolar and electro-anatomic mapping with the purpose of identify areas of abnormal electrograms (EGMs) as target for RFA and determine the location and size of the substrate.Results: When the greatest ST-segment elevation was in the 3rd intercostal space (ICS), the substrate was located upper in the longitudinal plane of the right ventricular outflow tract (RVOT) and a greatest ST-segment elevation in 4th ICS correspond with a location of substrate in lower region of longitudinal plane of RVOT. A QRS complex widening on its initial and final part, with prolonged transmural and regional depolarization time of RVOT corresponded to the substrate locateded in the anterior-lateral region of RVOT. A QRS complex widening rightwards and only prolonged transmural depolarization time corresponded with a substrate located in the anterior, anterior-septal or septal region of RVOT. RFA of endocardial substrate suppressed the inducibility and ECG BrS pattern during 34.7±15.5 months. After RFA, flecainide testing confirmed elimination of the ECG BrS pattern. Endocardial biopsy showed a correlation between functional and ultrastructural alterations in two patients.Keywords: Brugada syndrome; Radiofrequency catheter ablation; Electrocardiography; Mapping; Biopsy.Conclusion: Endocardial RFA can eliminate the BrS phenotype and inducibility during PVS.Fil: Tauber, Pablo E.. Centro Modelo del Corazón; Argentina. Gobierno de Tucumán. Ministerio de Salud. Hospital Centro de Salud "Zenón J. Santillán"; ArgentinaFil: Mansilla, Virginia. Centro Modelo del Corazón; ArgentinaFil: Brugada, Pedro. Free University of Brussels. Cardiovascular Division. Cardiovascular Institute; BélgicaFil: Sanchez, Sara Serafina del V.. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto Superior de Investigaciones Biológicas. Universidad Nacional de Tucumán. Instituto Superior de Investigaciones Biológicas; Argentina. Universidad Nacional de Tucumán. Facultad de Bioquímica, Química y Farmacia; ArgentinaFil: Honore, Stella Maris. Universidad Nacional de Tucumán. Facultad de Bioquímica, Química y Farmacia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto Superior de Investigaciones Biológicas. Universidad Nacional de Tucumán. Instituto Superior de Investigaciones Biológicas; ArgentinaFil: Elizari, Marcelo. Academia Nacional de Medicina de Buenos Aires; ArgentinaFil: Chain Molina, Sergio. Centro Modelo del Corazón; ArgentinaFil: Albano, Félix A.. Gobierno de Tucumán. Ministerio de Salud. Hospital Centro de Salud "Zenón J. Santillán"; ArgentinaFil: Corbalán, Ricardo R.. Centro Modelo del Corazón; ArgentinaFil: Figueroa Castellanos, Federico. Clínica Mayo; ArgentinaFil: Alzugaray, Damián. Abbott; ArgentinaAnnex Publishers2018-06info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/101940Tauber, Pablo E.; Mansilla, Virginia; Brugada, Pedro; Sanchez, Sara Serafina del V.; Honore, Stella Maris; et al.; Endocardial Approach for Substrate Ablation in Brugada Syndrome: Epicardial, Endocardial or Transmural Substrate?; Annex Publishers; Journal of Clinical and Experimental Research in Cardiology; 4; 1; 6-2018; 1-132394-6504CONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/url/http://www.annexpublishers.com/articles/JCERC/4101-Endocardial-Approach-for-Substrate-Ablation-in-Brugada-Syndrome-Epicardial-Endocardial-or-Transmural-Substrate.pdfinfo:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2025-09-03T10:08:00Zoai:ri.conicet.gov.ar:11336/101940instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982025-09-03 10:08:00.885CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse
dc.title.none.fl_str_mv Endocardial Approach for Substrate Ablation in Brugada Syndrome: Epicardial, Endocardial or Transmural Substrate?
title Endocardial Approach for Substrate Ablation in Brugada Syndrome: Epicardial, Endocardial or Transmural Substrate?
spellingShingle Endocardial Approach for Substrate Ablation in Brugada Syndrome: Epicardial, Endocardial or Transmural Substrate?
Tauber, Pablo E.
BRUGADA SYNDROME
ULTRASTRUCTURAL ALTERATIONS
ELECTROCARDIOGRAPHY
MAPPING
RADIOFREQUENCY CATHETER ABLATION
BIOPSY
title_short Endocardial Approach for Substrate Ablation in Brugada Syndrome: Epicardial, Endocardial or Transmural Substrate?
title_full Endocardial Approach for Substrate Ablation in Brugada Syndrome: Epicardial, Endocardial or Transmural Substrate?
title_fullStr Endocardial Approach for Substrate Ablation in Brugada Syndrome: Epicardial, Endocardial or Transmural Substrate?
title_full_unstemmed Endocardial Approach for Substrate Ablation in Brugada Syndrome: Epicardial, Endocardial or Transmural Substrate?
title_sort Endocardial Approach for Substrate Ablation in Brugada Syndrome: Epicardial, Endocardial or Transmural Substrate?
dc.creator.none.fl_str_mv Tauber, Pablo E.
Mansilla, Virginia
Brugada, Pedro
Sanchez, Sara Serafina del V.
Honore, Stella Maris
Elizari, Marcelo
Chain Molina, Sergio
Albano, Félix A.
Corbalán, Ricardo R.
Figueroa Castellanos, Federico
Alzugaray, Damián
author Tauber, Pablo E.
author_facet Tauber, Pablo E.
Mansilla, Virginia
Brugada, Pedro
Sanchez, Sara Serafina del V.
Honore, Stella Maris
Elizari, Marcelo
Chain Molina, Sergio
Albano, Félix A.
Corbalán, Ricardo R.
Figueroa Castellanos, Federico
Alzugaray, Damián
author_role author
author2 Mansilla, Virginia
Brugada, Pedro
Sanchez, Sara Serafina del V.
Honore, Stella Maris
Elizari, Marcelo
Chain Molina, Sergio
Albano, Félix A.
Corbalán, Ricardo R.
Figueroa Castellanos, Federico
Alzugaray, Damián
author2_role author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv BRUGADA SYNDROME
ULTRASTRUCTURAL ALTERATIONS
ELECTROCARDIOGRAPHY
MAPPING
RADIOFREQUENCY CATHETER ABLATION
BIOPSY
topic BRUGADA SYNDROME
ULTRASTRUCTURAL ALTERATIONS
ELECTROCARDIOGRAPHY
MAPPING
RADIOFREQUENCY CATHETER ABLATION
BIOPSY
purl_subject.fl_str_mv https://purl.org/becyt/ford/1.6
https://purl.org/becyt/ford/1
dc.description.none.fl_txt_mv Background: Radiofrequency ablation (RFA) in Brugada syndrome (BrS) has been performed both endocardially and epicardially. The substrate in BrS is thus unclear.Objectives: To investigate the functional endocardial substrate and its correlation with clinical, electrophysiological and ECG findings in order to guide an endocardial ablation.Methods: Thirteen patients (38.7±12.3 years old) with spontaneous type 1 ECG BrS pattern, inducible VF with programmed ventricular stimulation (PVS) and syncope without prodromes were enrolled. Before to endocardial mapping the patients underwent flecainide testing with the purpose of measuring the greatest ST-segment elevation for to be correlated with the size and location of substrate in the electro-anatomic map. Patients underwent endocardial bipolar and electro-anatomic mapping with the purpose of identify areas of abnormal electrograms (EGMs) as target for RFA and determine the location and size of the substrate.Results: When the greatest ST-segment elevation was in the 3rd intercostal space (ICS), the substrate was located upper in the longitudinal plane of the right ventricular outflow tract (RVOT) and a greatest ST-segment elevation in 4th ICS correspond with a location of substrate in lower region of longitudinal plane of RVOT. A QRS complex widening on its initial and final part, with prolonged transmural and regional depolarization time of RVOT corresponded to the substrate locateded in the anterior-lateral region of RVOT. A QRS complex widening rightwards and only prolonged transmural depolarization time corresponded with a substrate located in the anterior, anterior-septal or septal region of RVOT. RFA of endocardial substrate suppressed the inducibility and ECG BrS pattern during 34.7±15.5 months. After RFA, flecainide testing confirmed elimination of the ECG BrS pattern. Endocardial biopsy showed a correlation between functional and ultrastructural alterations in two patients.Keywords: Brugada syndrome; Radiofrequency catheter ablation; Electrocardiography; Mapping; Biopsy.Conclusion: Endocardial RFA can eliminate the BrS phenotype and inducibility during PVS.
Fil: Tauber, Pablo E.. Centro Modelo del Corazón; Argentina. Gobierno de Tucumán. Ministerio de Salud. Hospital Centro de Salud "Zenón J. Santillán"; Argentina
Fil: Mansilla, Virginia. Centro Modelo del Corazón; Argentina
Fil: Brugada, Pedro. Free University of Brussels. Cardiovascular Division. Cardiovascular Institute; Bélgica
Fil: Sanchez, Sara Serafina del V.. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto Superior de Investigaciones Biológicas. Universidad Nacional de Tucumán. Instituto Superior de Investigaciones Biológicas; Argentina. Universidad Nacional de Tucumán. Facultad de Bioquímica, Química y Farmacia; Argentina
Fil: Honore, Stella Maris. Universidad Nacional de Tucumán. Facultad de Bioquímica, Química y Farmacia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto Superior de Investigaciones Biológicas. Universidad Nacional de Tucumán. Instituto Superior de Investigaciones Biológicas; Argentina
Fil: Elizari, Marcelo. Academia Nacional de Medicina de Buenos Aires; Argentina
Fil: Chain Molina, Sergio. Centro Modelo del Corazón; Argentina
Fil: Albano, Félix A.. Gobierno de Tucumán. Ministerio de Salud. Hospital Centro de Salud "Zenón J. Santillán"; Argentina
Fil: Corbalán, Ricardo R.. Centro Modelo del Corazón; Argentina
Fil: Figueroa Castellanos, Federico. Clínica Mayo; Argentina
Fil: Alzugaray, Damián. Abbott; Argentina
description Background: Radiofrequency ablation (RFA) in Brugada syndrome (BrS) has been performed both endocardially and epicardially. The substrate in BrS is thus unclear.Objectives: To investigate the functional endocardial substrate and its correlation with clinical, electrophysiological and ECG findings in order to guide an endocardial ablation.Methods: Thirteen patients (38.7±12.3 years old) with spontaneous type 1 ECG BrS pattern, inducible VF with programmed ventricular stimulation (PVS) and syncope without prodromes were enrolled. Before to endocardial mapping the patients underwent flecainide testing with the purpose of measuring the greatest ST-segment elevation for to be correlated with the size and location of substrate in the electro-anatomic map. Patients underwent endocardial bipolar and electro-anatomic mapping with the purpose of identify areas of abnormal electrograms (EGMs) as target for RFA and determine the location and size of the substrate.Results: When the greatest ST-segment elevation was in the 3rd intercostal space (ICS), the substrate was located upper in the longitudinal plane of the right ventricular outflow tract (RVOT) and a greatest ST-segment elevation in 4th ICS correspond with a location of substrate in lower region of longitudinal plane of RVOT. A QRS complex widening on its initial and final part, with prolonged transmural and regional depolarization time of RVOT corresponded to the substrate locateded in the anterior-lateral region of RVOT. A QRS complex widening rightwards and only prolonged transmural depolarization time corresponded with a substrate located in the anterior, anterior-septal or septal region of RVOT. RFA of endocardial substrate suppressed the inducibility and ECG BrS pattern during 34.7±15.5 months. After RFA, flecainide testing confirmed elimination of the ECG BrS pattern. Endocardial biopsy showed a correlation between functional and ultrastructural alterations in two patients.Keywords: Brugada syndrome; Radiofrequency catheter ablation; Electrocardiography; Mapping; Biopsy.Conclusion: Endocardial RFA can eliminate the BrS phenotype and inducibility during PVS.
publishDate 2018
dc.date.none.fl_str_mv 2018-06
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
http://purl.org/coar/resource_type/c_6501
info:ar-repo/semantics/articulo
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/11336/101940
Tauber, Pablo E.; Mansilla, Virginia; Brugada, Pedro; Sanchez, Sara Serafina del V.; Honore, Stella Maris; et al.; Endocardial Approach for Substrate Ablation in Brugada Syndrome: Epicardial, Endocardial or Transmural Substrate?; Annex Publishers; Journal of Clinical and Experimental Research in Cardiology; 4; 1; 6-2018; 1-13
2394-6504
CONICET Digital
CONICET
url http://hdl.handle.net/11336/101940
identifier_str_mv Tauber, Pablo E.; Mansilla, Virginia; Brugada, Pedro; Sanchez, Sara Serafina del V.; Honore, Stella Maris; et al.; Endocardial Approach for Substrate Ablation in Brugada Syndrome: Epicardial, Endocardial or Transmural Substrate?; Annex Publishers; Journal of Clinical and Experimental Research in Cardiology; 4; 1; 6-2018; 1-13
2394-6504
CONICET Digital
CONICET
dc.language.none.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv info:eu-repo/semantics/altIdentifier/url/http://www.annexpublishers.com/articles/JCERC/4101-Endocardial-Approach-for-Substrate-Ablation-in-Brugada-Syndrome-Epicardial-Endocardial-or-Transmural-Substrate.pdf
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
https://creativecommons.org/licenses/by/2.5/ar/
eu_rights_str_mv openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by/2.5/ar/
dc.format.none.fl_str_mv application/pdf
application/pdf
application/pdf
dc.publisher.none.fl_str_mv Annex Publishers
publisher.none.fl_str_mv Annex Publishers
dc.source.none.fl_str_mv reponame:CONICET Digital (CONICET)
instname:Consejo Nacional de Investigaciones Científicas y Técnicas
reponame_str CONICET Digital (CONICET)
collection CONICET Digital (CONICET)
instname_str Consejo Nacional de Investigaciones Científicas y Técnicas
repository.name.fl_str_mv CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicas
repository.mail.fl_str_mv dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar
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score 13.13397

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