Pannone, L., Della Rocca, D. G., Vergara, P., Sorgente, A., Del Monte, A., Vetta, G., Cespon Fernandez, M., Talevi, G., Eltsov, I., Calburean, P.-A., Overeinder, I., Bala, G., Almorad, A., Ströker, E., Pappaert, G., Sieira, J., de Ravel, T., Van Dooren, S., Gharaviri, A., ... de Asmundis, C. (2024). In Vivo Mapping of Human Ventricular Fibrillation in Brugada Syndrome: The Role of Repolarization Heterogeneity. Circulation: Arrhythmia and Electrophysiology, 17(12), Article e013290. https://doi.org/10.1161/CIRCEP.124.013290

@article{34b12e200b5245bab22d8711aefe5247,
title = "In Vivo Mapping of Human Ventricular Fibrillation in Brugada Syndrome: The Role of Repolarization Heterogeneity",
abstract = "BACKGROUND: Brugada syndrome (BrS) is associated with ventricular fibrillation (VF). Different VF mechanisms have been described, and repolarization gradients were associated with VF in a BrS model. The aim of this study is to map VF in BrS with ECG imaging. Furthermore, spatial correlation between sinus rhythm maps and VF maps was evaluated.METHODS: Inclusion criteria were (1) BrS diagnosis and (2) VF mapped with ECG imaging during right ventricle outflow tract ablation. VF mechanism was classified into (1) rotational, (2) focal, and (3) irregular. For comparison, 6 controls were enrolled. The following sinus rhythm maps were performed: activation, recovery time, and activation-recovery interval time. Spatial overlap between steep repolarization gradients (cliffs) at recovery time and activation-recovery interval time maps and initiating VF rotational activity was evaluated with photogrammetry.RESULTS: A total of 28 VF maps in 21 patients with BrS were analyzed. In the first ≈7 seconds of VF, rotational, focal, and irregular mechanisms were found. In 19 patients with BrS (90.5\%) and none of the controls, a right ventricle outflow tract repolarization cliff only was found. In all these patients, the singularity point of the first initiating rotational VF activity spatially overlapped with the right ventricle outflow tract cliff. Abolition of right ventricle outflow tract repolarization cliffs was confirmed in all but 2 patients (94.3\%). In one patient with recurrence, VF was mapped on the anterior right ventricle over a cliff that was not targeted at the first ablation procedure.CONCLUSIONS: In patients with BrS, repolarization heterogeneity has a critical role in VF. Repolarization cliffs might be a therapeutic target in VF ablation.",
keywords = "Brugada syndrome, coronary angiography, death, sudden, cardiac, heart ventricles, ventricular fibrillation",
author = "Luigi Pannone and \{Della Rocca\}, \{Domenico Giovanni\} and Pasquale Vergara and Antonio Sorgente and \{Del Monte\}, Alvise and Giampaolo Vetta and \{Cespon Fernandez\}, Maria and Giacomo Talevi and Ivan Eltsov and Paul-Adrian Calburean and Ingrid Overeinder and Gezim Bala and Alexandre Almorad and Erwin Str{\"o}ker and Gudrun Pappaert and Juan Sieira and \{de Ravel\}, Thomy and \{Van Dooren\}, Sonia and Ali Gharaviri and \{La Meir\}, Mark and Pedro Brugada and Chierchia, \{Gian Battista\} and Andrea Sarkozy and \{de Asmundis\}, Carlo",
note = "Funding Information: Dr Sorgente received research grants from Daiichi Sankyo and Bayer; he received speaker fees from Menarini and Bayer. Dr La Meir is a consultant for AtriCure. Dr Chierchia received compensation for teaching purposes and proctoring from Medtronic, Abbott, Biotronik, and Boston Scientific. Dr Sarkozy is a consultant for Biosense Webster and Medtronic and received speaker fees from Biosense Webster, Biotronik, Pfizer, and Microport. Dr de Asmundis receives research grants on behalf of the center from Biotronik, Medtronic, Abbott, Microport, Boston Scientific, and AtriCure. Dr de Asmundis received compensation for teaching purposes and proctoring from Medtronic, Abbott, Biotronik, MicroPort, Boston Scientific, AtriCure, and Daiichi Sankyo. The other authors report no conflicts. Publisher Copyright: {\textcopyright} 2024 American Heart Association, Inc.",
year = "2024",
month = dec,
doi = "10.1161/CIRCEP.124.013290",
language = "English",
volume = "17",
journal = "Circulation: Arrhythmia and Electrophysiology",
issn = "1941-3149",
publisher = "Lippincott Williams and Wilkins",
number = "12",
}