1. Novel CineECG Derived From Standard 12-Lead ECG Enables Right Ventricle Outflow Tract Localization of Electrical Substrate in Patients With Brugada Syndrome
- Author
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Emanuela T Locati, Luigi Anastasia, Žarko Ćalović, Giuseppe Ciconte, Peter M van Dam, Valeria Borrelli, Valerio Mecarocci, Michelle M. Monasky, Gabriele Vicedomini, Vincenzo Santinelli, Luigi Giannelli, Francesca Heilbron, Carlo Pappone, Emanuele Micaglio, Van Dam, P. M., Locati, E. T., Ciconte, G., Borrelli, V., Heilbron, F., Santinelli, V., Vicedomini, G., Monasky, M. M., Micaglio, E., Giannelli, L., Mecarocci, V., Calovic, Z., Anastasia, L., and Pappone, C.
- Subjects
Adult ,Male ,medicine.medical_specialty ,Heart Ventricles ,Bundle-Branch Block ,Vectorcardiography ,12 lead ecg ,Action Potentials ,electrocardiogram ,030204 cardiovascular system & hematology ,sudden cardiac death ,Sudden cardiac death ,Electrocardiography ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Heart Rate ,Predictive Value of Tests ,Physiology (medical) ,Internal medicine ,bundle branch block ,medicine ,Humans ,Brugada syndrome ,In patient ,Registries ,030212 general & internal medicine ,ajmaline ,Right ventricle outflow tract ,Brugada Syndrome ,medicine.diagnostic_test ,Bundle branch block ,business.industry ,Signal Processing, Computer-Assisted ,vectorcardiography ,Middle Aged ,medicine.disease ,Ajmaline ,Case-Control Studies ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Algorithms ,medicine.drug - Abstract
Background: In Brugada syndrome (BrS), diagnosed in presence of a spontaneous or ajmaline-induced type-1 pattern, ventricular arrhythmias originate from the right ventricle outflow tract (RVOT). We developed a novel CineECG method, obtained by inverse electrocardiogram (ECG) from standard 12-lead ECG, to localize the electrical activity pathway in patients with BrS. Methods: The CineECG enabled the temporospatial localization of the ECG waveforms, deriving the mean temporospatial isochrone from standard 12-lead ECG. The study sample included (1) 15 patients with spontaneous type-1 Brugada pattern, and (2) 18 patients with ajmaline-induced BrS (at baseline and after ajmaline), in whom epicardial potential duration maps were available; (3) 17 type-3 BrS pattern patients not showing type-1 BrS pattern after ajmaline (ajmaline-negative); (4) 47 normal subjects; (5) 18 patients with right bundle branch block (RBBB). According to CineECG algorithm, each ECG was classified as Normal, Brugada, RBBB, or Undetermined. Results: In patients with spontaneous or ajmaline-induced BrS, CineECG localized the terminal mean temporospatial isochrone forces in the RVOT, congruent with the arrhythmogenic substrate location detected by epicardial potential duration maps. The RVOT location was never observed in normal, RBBB, or ajmaline-negative patients. In most patients with ajmaline-induced BrS (78%), the RVOT location was already evident at baseline. The CineECG classified all normal subjects and ajmaline-negative patients at baseline as Normal or Undetermined, all patients with RBBB as RBBB, whereas all patients with spontaneous and ajmaline-induced BrS as Brugada. Compared with standard 12-lead ECG, CineECG at baseline had a 100% positive predictive value and 81% negative predictive value in predicting ajmaline test results. Conclusions: In patients with spontaneous and ajmaline-induced BrS, the CineECG localized the late QRS activity in the RVOT, a phenomenon never observed in normal, RBBB, or ajmaline-negative patients. The possibility to identify the RVOT as the location of the arrhythmogenic substrate by the noninvasive CineECG, based on the standard 12-lead ECG, opens new prospective for diagnosing patients with BrS.
- Published
- 2020
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