Longer Repolarization in the Epicardium at the Right Ventricular Outflow Tract Causes Type 1 Electrocardiogram in Patients With Brugada Syndrome

Nagase, Satoshi; Kusano, Kengo Fukushima; Morita, Hiroshi; Nishii, Nobuhiro; Banba, Kimikazu; Watanabe, Atsuyuki; Hiramatsu, Shigeki; Nakamura, Kazufumi; Sakuragi, Satoru; Ohe, Tohru

doi:10.1016/j.jacc.2007.10.059

Cited by 76Cardiac electrophysiology and arrhythmiasCardiac Arrhythmias and TreatmentsCardiovascular Effects of Exercise

Longer Repolarization in the Epicardium at the Right Ventricular Outflow Tract Causes Type 1 Electrocardiogram in Patients With Brugada Syndrome

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Nagase, Satoshi, Kusano, Kengo Fukushima, Morita, Hiroshi, Nishii, Nobuhiro, Banba, Kimikazu, Watanabe, Atsuyuki, Hiramatsu, Shigeki, Nakamura, Kazufumi +2 more·2008·Journal of the American College of Cardiology

DOI 10.1016/j.jacc.2007.10.059

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Abstract

Objectives We examined the relationship between repolarization abnormality and coved-type ST-segment elevation with terminal inverted T-wave (type 1 electrocardiogram [ECG]) in patients with Brugada syndrome (BrS).Background Recent experimental studies have suggested that accentuation of the right ventricular action potential (AP) notch preferentially prolongs epicardial AP causing inversion of the T-wave.Methods In 19 patients with BrS and 3 control subjects, activation-recovery intervals (ARIs) and repolarization times (RTs) in the epicardium and endocardium were directly examined with the use of local unipolar electrograms at the right ventricular outflow tract. Surface ECG, ARI, and RT were examined before and after administration of pilsicainide.Results Type 1 ECG was observed in 10 of the 19 BrS patients before the administration of pilsicainide and in all of the 19 patients after the administration of pilsicainide. We found that ARI and RT in the epicardium were shorter than those in the endocardium in all 9 BrS patients without type 1 ECG under baseline conditions and in all control subjects regardless of pilsicainide administration. However, longer epicardial ARI than endocardial ARI was observed in 8 of the 10 BrS patients manifesting type 1 ECG under baseline conditions and in all of the BrS patients after the administration of pilsicainide. Also, epicardial RT was longer than endocardial RT in all patients manifesting type 1 ECG regardless of pilsicainide administration.Conclusions Our data provide support for the hypothesis that the negative T-wave associated with type 1 BrS ECG is due to a preferential prolongation of the epicardial AP secondary to accentuation of the AP notch in the region of the right ventricular outflow tract.

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The negative T wave associated with Type-1 Brugada syndrome is due to a preferential prolongation of repolarization in the epicardium compared with that in the endocardium.
“The same group of investigators supported evidence that the negative T wave associated with Type-1 BS is due to a preferential prolongation of repolarization in the epicardium compared with that in the endocardium.31”
From The Year of 2008 in Electrocardiology (2010) · cites this paper as [31]

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Additional file 2 of Whole exome sequencing with a focus on cardiac disease-associated genes in families of sudden unexplained deaths in Yunnan, southwest of China
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Additional file 5 of Whole exome sequencing with a focus on cardiac disease-associated genes in families of sudden unexplained deaths in Yunnan, southwest of China
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Additional file 3 of Whole exome sequencing with a focus on cardiac disease-associated genes in families of sudden unexplained deaths in Yunnan, southwest of China
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Additional file 4 of Whole exome sequencing with a focus on cardiac disease-associated genes in families of sudden unexplained deaths in Yunnan, southwest of China
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Additional file 1 of Whole exome sequencing with a focus on cardiac disease-associated genes in families of sudden unexplained deaths in Yunnan, southwest of China
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Authors: Nagase, S., Kusano, K. F., Morita, H., Nishii, N., Banba, K., Watanabe, A., Hiramatsu, S., Nakamura, K., Sakuragi, S., & Ohe, T.
Affiliations: Okayama University (JP)
Corresponding author: Nagase, Satoshi
ORCID: Nagase, Satoshi
Kusano, Kengo Fukushima
Morita, Hiroshi
Nishii, Nobuhiro
Watanabe, Atsuyuki
Hiramatsu, Shigeki
Nakamura, Kazufumi
Sakuragi, Satoru
Ohe, Tohru
Venue: Journal of the American College of Cardiology
Publisher: Elsevier BV
Published: 2008-03
Volume: 51
Issue: 12
Pages: 1154-1161
ISSN: 0735-1097 (ISSN-L)
DOI: 10.1016/j.jacc.2007.10.059
OpenAlex: W2130808721
Cited by: 75
References: 29
Citations by year: 2026: 1 · 2024: 6 · 2023: 5 · 2021: 1 · 2020: 3 · 2019: 1 · 2018: 2 · 2017: 4 · 2016: 4 · 2015: 6 · 2014: 5 · 2013: 4 · 2012: 6
FWCI: 6.57
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 1963 d)
Locations: Journal of the American College of Cardiology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
Keywords: Brugada syndrome, right ventricular outflow tract, activation-recovery interval, repolarization time, pilsicainide, T-wave inversion
MeSH terms: Action Potentials, Adult, Aged, Electrocardiography, Endocardium, Female, Heart Conduction System, Heart Ventricles, Humans, Lidocaine, Male, Middle Aged, Pericardium, Case-Control Studies, Sodium Channel Blockers, Brugada Syndrome

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Longer Repolarization in the Epicardium at the Right Ventricular Outflow Tract Causes Type 1 Electrocardiogram in Patients With Brugada Syndrome

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