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The electrophysiologic mechanism of ST-segment elevation in Brugada syndrome.

Abstract：

OBJECTIVES:We sought to demonstrate the electrophysiologic (EP) mechanism of the ST-T change in Brugada syndrome. BACKGROUND:Brugada syndrome is characterized by various electrocardiographic manifestations (e.g., right bundle branch block, ST-segment elevation, and terminal T-wave inversion in the right precordial leads) and sudden cardiac death caused by ventricular fibrillation. Direct evidence in support of the EP mechanism underlying this intriguing syndrome has been lacking. METHODS:Monophasic action potentials (MAPs) were obtained from three patients with the coved-type ST-segment elevation (Brugada patients) and five control patients using the contact electrode method. Epicardial MAPs were recorded during open-chest surgery in all patients. RESULTS:A spike-and-dome configuration was documented from epicardial sites of the right ventricular (RV) outflow tract in all Brugada patients but not in control patients. Monophasic action potential recordings from the endocardium with special focus on the RV outflow tract could not demonstrate any morphological abnormalities in three Brugada patients. CONCLUSIONS:The presence of a deeply notched action potential in the RV epicardium, but not in endocardium, would be expected to induce a transmural current that would contribute to elevation of the ST-segment in the right precordial leads. The spike-and-dome configuration may also prolong the epicardial action potential, thus contributing to a rapid reversal of the transmural gradients and inscription of an inverted T-wave.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Kurita T,Shimizu W,Inagaki M,Suyama K,Taguchi A,Satomi K,Aihara N,Kamakura S,Kobayashi J,Kosakai Y

doi

10.1016/s0735-1097(02)01964-2

subject

Has Abstract

pub_date

2002-07-17 00:00:00

pages

330-4

issue

2

eissn

0735-1097

issn

1558-3597

pii

S0735109702019642

journal_volume

40

pub_type

杂志文章

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