Emanuela T Locati, Peter M Van Dam, Giuseppe Ciconte, Francesca Heilbron, Machteld Boonstra, Gabriele Vicedomini, Emanuele Micaglio, Žarko Ćalović, Luigi Anastasia, Vincenzo Santinelli, Carlo Pappone
{"title":"Brugada综合征心外膜致心律失常底物消融后去极化和复极化变化的心电图时空评价","authors":"Emanuela T Locati, Peter M Van Dam, Giuseppe Ciconte, Francesca Heilbron, Machteld Boonstra, Gabriele Vicedomini, Emanuele Micaglio, Žarko Ćalović, Luigi Anastasia, Vincenzo Santinelli, Carlo Pappone","doi":"10.1093/ehjdh/ztad050","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>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.</p><p><strong>Methods and results: </strong>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, <i>P</i> < 0.001; 454 ± 40 vs. 421 ± 27 ms, <i>P</i> < 0.000). Baseline QRS amplitude was lower and increased at late FU (0.63 ± 0.26 vs. 0.84 ± 13 ms, <i>P</i> < 0.000), while Terminal-QRS amplitude decreased (0.24 ± 0.07 vs. 0.08 ± 0.03 ms, <i>P</i> < 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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":72965,"journal":{"name":"European heart journal. Digital health","volume":null,"pages":null},"PeriodicalIF":3.9000,"publicationDate":"2023-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689926/pdf/","citationCount":"0","resultStr":"{\"title\":\"Electrocardiographic temporo-spatial assessment of depolarization and repolarization changes after epicardial arrhythmogenic substrate ablation in Brugada syndrome.\",\"authors\":\"Emanuela T Locati, Peter M Van Dam, Giuseppe Ciconte, Francesca Heilbron, Machteld Boonstra, Gabriele Vicedomini, Emanuele Micaglio, Žarko Ćalović, Luigi Anastasia, Vincenzo Santinelli, Carlo Pappone\",\"doi\":\"10.1093/ehjdh/ztad050\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>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.</p><p><strong>Methods and results: </strong>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, <i>P</i> < 0.001; 454 ± 40 vs. 421 ± 27 ms, <i>P</i> < 0.000). Baseline QRS amplitude was lower and increased at late FU (0.63 ± 0.26 vs. 0.84 ± 13 ms, <i>P</i> < 0.000), while Terminal-QRS amplitude decreased (0.24 ± 0.07 vs. 0.08 ± 0.03 ms, <i>P</i> < 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.</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":72965,\"journal\":{\"name\":\"European heart journal. Digital health\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.9000,\"publicationDate\":\"2023-09-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689926/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European heart journal. 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引用次数: 0
摘要
在brugada综合征(BrS)中,自发性或ajmalin诱导的cove st段抬高,心外膜电解剖电位-持续时间图(epi-PDM)在右心室(RV)流出道(RVOT)上检测到心律失常-底区(AS-area),心外膜射频消融(EPI-AS-RFA)消除。新型CineECG,在3d心脏模型上投射12导联心电图波形,先前定位了brs患者RV/RVOT的去极化力。与正常对照比较,评价自发性1型brs患者在epi - as - rfa前后的12导联心电图和CineECG去极化/复极化变化。30例高危brs患者(93%男性,年龄37+9岁)在基线、epi- as - rfa后早期和随访后期(2.7-16.1个月)获得12导联心电图和epi-PDMs。CineECG估计去极化(早期qrs和终端qrs)和复极化(ST-Tpeak, Tpeak-Tend)期间的时间空间定位。采用wilcoxon - sign - rank检验分析brs患者之间的差异(基线、早期、后期随访),采用Mann-Whitney检验分析brs患者与60名年龄-性别匹配的正常对照之间的差异。在brs患者中,基线QRS和QTc持续时间更长,并在EPI-AS-ATC后恢复正常(151±15 vs 102±13 ms, p<0.001;454±40 vs. 421±27 ms, p<0.000)。基线qrs振幅较低且在fu晚期升高(0.63±0.26 vs. 0.84±13 ms, p<0.000),终末qrs振幅降低(0.24±0.07 vs. 0.08±0.03 ms, p<0.000)。基线时,CineECG去极化/复极化波前普遍定位于RV/RVOT (Terminal-QRS 57%;ST-Tpeak, 100%;Tpeak-T-end, 61%),与epi-PDM上的as区域一致。EPI-AS-RFA术后早期,去极化期间的RV/RVOT定位消失,终端- qrs主要定位于左心室(LV, 76%),而复极化仍定位于RV/RVOT (ST-Tpeak(44%)和Tpeak-Tend(98%))。在晚期fu,去极化/复极化力普遍定位于左室(Terminal-QRS 94%, ST-Tpeak 63%, Tpeak-Tend 86%),与正常对照组一样。CineECG和12导联心电图显示brs患者的去极化和复极化存在复杂的时空扰动,通常局限于RV/RVOT,在心外膜消融后逐渐恢复正常。
Electrocardiographic temporo-spatial assessment of depolarization and repolarization changes after epicardial arrhythmogenic substrate ablation in Brugada syndrome.
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.