Ventricular Tachycardia and Early Fibrillation in Patients With Brugada Syndrome and Ischemic Cardiomyopathy Show Predictable Frequency-Phase Properties on the Precordial ECG Consistent With the Respective Arrhythmogenic Substrate

被引：7

作者：

Calvo, David ^{[1
]}

Atienza, Felipe ^{[3
]}

Saiz, Javier ^{[4
]}

Martinez, Laura ^{[4
]}

Avila, Pablo ^{[3
]}

Rubin, Jose ^{[1
]}

Herreros, Benito ^{[5
,6
]}

Arenal, Angel ^{[3
]}

Garcia-Fernandez, Javier ^{[5
,6
]}

Ferrer, Ana ^{[4
]}

Sebastian, Rafael ^{[7
]}

Martinez-Camblor, Pablo ^{[8
]}

Jalife, Jose ^{[2
]}

Berenfeld, Omer ^{[2
]}

机构：

[1] Hosp Univ Cent Asturias, Arrhythmia Unit, Oviedo, Spain

[2] Univ Michigan, Ctr Arrhythmia Res, Ann Arbor, MI 48109 USA

[3] Hosp Gen Univ Gregorio Maranon, Arrhythmia Unit, Madrid, Spain

[4] Univ Politecn Valencia, Ctr Invest & Innovac Bioingn, Ci2B, E-46071 Valencia, Spain

[5] Hosp Rio Hortega Valladolid, Arrhythmia Unit, Valladolid, Spain

[6] Univ Burgos, Valladolid, Spain

[7] Univ Valencia, Valencia, Spain

[8] Hosp Univ Cent Asturias, Dept Stat, Oviedo, Spain

来源：

CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY | 2015年 / 8卷 / 05期

关键词：

Brugada syndrome; electrocardiography; myocardial infarction; tachycardia; ventricular; ventricular fibrillation; CATHETER ABLATION; HUMAN HEART; CARDIAC FIBRILLATION; ATRIAL-FIBRILLATION; POTASSIUM CURRENT; WAVE-FRONTS; PIG-HEART; ACTIVATION; MECHANISMS; CHANNEL;

D O I：

10.1161/CIRCEP.114.002717

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Ventricular fibrillation (VF) has been proposed to be maintained by localized high-frequency sources. We tested whether spectral-phase analysis of the precordial ECG enabled identification of periodic activation patterns generated by such sources. Methods and Results Precordial ECGs were recorded from 15 ischemic cardiomyopathy and 15 Brugada syndrome (type 1 ECG) patients during induced VF and analyzed in the frequency-phase domain. Despite temporal variability, induced VF episodes lasting 19.67.9 s displayed distinctly high power at a common frequency (shared frequency, 5.7 +/- 1.1 Hz) in all leads about half of the time. In patients with Brugada syndrome, phase analysis of shared frequency showed a V-1-V-6 sequence as would be expected from patients displaying a type 1 ECG pattern (P<0.001). Hilbert-based phases confirmed that the most stable sequence over the whole VF duration was V-1-V-6. Analysis of shared frequency in ischemic cardiomyopathy patients with anteroseptal (n=4), apical (n=3), and inferolateral (n=4) myocardial infarction displayed a sequence starting at V-1-V-2, V-3-V-4, and V-5-V-6, respectively, consistent with an activation origin at the scar location (P=0.005). Sequences correlated with the Hilbert-based phase analysis (P<0.001). Posterior infarction (n=4) displayed no specific sequence. On paired comparison, phase sequences during monomorphic ventricular tachycardia correlated moderately with VF (P<0.001). Moreover, there was a dominant frequency gradient from precordial leads facing the scar region to the contralateral leads (5.8 +/- 0.8 versus 5.4 +/- 1.1 Hz; P=0.004). Conclusions Noninvasive analysis of ventricular tachycardia and early VF in patients with Brugada syndrome and ischemic cardiomyopathy shows a predictable sequence in the frequency-phase domain, consistent with anatomic location of the arrhythmogenic substrate.

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页码：1133 / 1143

页数：11