Dynamics of unipolar J-ST elevation coupled to bipolar delayed potentials on the epicardium in Brugada syndrome: a case report.
Brugada syndrome
Case report
Epicardium
J-ST elevation
Localized conduction block
Journal
European heart journal. Case reports
ISSN: 2514-2119
Titre abrégé: Eur Heart J Case Rep
Pays: England
ID NLM: 101730741
Informations de publication
Date de publication:
Aug 2023
Aug 2023
Historique:
received:
08
01
2023
revised:
21
07
2023
accepted:
31
07
2023
medline:
14
8
2023
pubmed:
14
8
2023
entrez:
14
8
2023
Statut:
epublish
Résumé
The area of abnormal bipolar potentials in the right ventricular epicardium is recognized as an arrhythmogenic substrate in patients with Brugada syndrome (BrS); however, the correlation between local potentials and Brugada-type surface electrocardiograms (ECGs) remains unclear. A 49-year-old man with BrS who was hospitalized for refractory ventricular fibrillation underwent an electrocardiographic study with unipolar electrodes with the same bandwidth as surface ECGs. The right ventricular outflow tract epicardium showed abnormal bipolar potentials composed of split sharp and delayed dull components with coved-type J-ST elevation in the unipolar electrodes. The additional stimuli from the atrium gradually decreased the number of unipolar electrodes showing coved-type J-ST elevation along with a shortening of the local bipolar activation time. The pilsicainide provocation test induced a change in unipolar morphology from coved type to convex type and an intermittent local block of the divided and sharp components in bipolar electrodes. Of note, the unipolar J-ST elevation was not changed along with the localized conduction block in bipolar leads. The unipolar electrode waveforms during sinus rhythm change together with bipolar electrodes, consisting of sharp and blunt components in BrS. However, the convex-type J-ST elevation in unipolar leads persisted irrespective of the local conduction block in bipolar leads after pilsicainide provocation. These findings suggest the complexity of BrS mechanisms.
Sections du résumé
Background
UNASSIGNED
The area of abnormal bipolar potentials in the right ventricular epicardium is recognized as an arrhythmogenic substrate in patients with Brugada syndrome (BrS); however, the correlation between local potentials and Brugada-type surface electrocardiograms (ECGs) remains unclear.
Case summary
UNASSIGNED
A 49-year-old man with BrS who was hospitalized for refractory ventricular fibrillation underwent an electrocardiographic study with unipolar electrodes with the same bandwidth as surface ECGs. The right ventricular outflow tract epicardium showed abnormal bipolar potentials composed of split sharp and delayed dull components with coved-type J-ST elevation in the unipolar electrodes. The additional stimuli from the atrium gradually decreased the number of unipolar electrodes showing coved-type J-ST elevation along with a shortening of the local bipolar activation time. The pilsicainide provocation test induced a change in unipolar morphology from coved type to convex type and an intermittent local block of the divided and sharp components in bipolar electrodes. Of note, the unipolar J-ST elevation was not changed along with the localized conduction block in bipolar leads.
Discussion
UNASSIGNED
The unipolar electrode waveforms during sinus rhythm change together with bipolar electrodes, consisting of sharp and blunt components in BrS. However, the convex-type J-ST elevation in unipolar leads persisted irrespective of the local conduction block in bipolar leads after pilsicainide provocation. These findings suggest the complexity of BrS mechanisms.
Identifiants
pubmed: 37575530
doi: 10.1093/ehjcr/ytad377
pii: ytad377
pmc: PMC10415855
doi:
Types de publication
Case Reports
Langues
eng
Pagination
ytad377Informations de copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
Déclaration de conflit d'intérêts
Conflict of interest: S.N. is affiliated with a department endowed by Japan Medtronic Inc. The remaining authors have nothing to disclose.
Références
JACC Clin Electrophysiol. 2017 Apr;3(4):353-363
pubmed: 28948234
J Mol Cell Cardiol. 2010 Oct;49(4):543-53
pubmed: 20659475
Circulation. 2011 Mar 29;123(12):1270-9
pubmed: 21403098
HeartRhythm Case Rep. 2017 Oct 13;3(12):595-598
pubmed: 29296584
Circulation. 2004 Aug 31;110(9):1036-41
pubmed: 15302777
Heart Rhythm. 2022 Mar;19(3):397-404
pubmed: 34601129
Circ Arrhythm Electrophysiol. 2015 Dec;8(6):1382-92
pubmed: 26480928
Heart Rhythm. 2022 Mar;19(3):417-426
pubmed: 34737095