Author + information
- Received May 4, 2007
- Revision received September 24, 2007
- Accepted October 17, 2007
- Published online March 25, 2008.
- Satoshi Nagase, MD⁎ (, )
- Kengo Fukushima Kusano, MD,
- Hiroshi Morita, MD,
- Nobuhiro Nishii, MD,
- Kimikazu Banba, MD,
- Atsuyuki Watanabe, MD,
- Shigeki Hiramatsu, MD,
- Kazufumi Nakamura, MD,
- Satoru Sakuragi, MD and
- Tohru Ohe, MD
- ↵⁎Reprint requests and correspondence:
Dr. Satoshi Nagase, Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama 700-8558, Japan.
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.
- Received May 4, 2007.
- Revision received September 24, 2007.
- Accepted October 17, 2007.
- American College of Cardiology Foundation