Epicardial ablation eliminates ventricular arrhythmias in an experimental model of Brugada syndrome

Hiroshi Morita, Douglas P. Zipes, Shiho T. Morita, John C. Lopshire, Jiashin Wu

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Background: Although radiofrequency catheter ablation (RFCA) has been used to treat patients with Brugada syndrome (BS), it is difficult to eliminate polymorphic ventricular tachycardias (VTs) completely. Objective: The purpose of this study was to determine the efficacy of RFCA in eliminating recurrent VTs in an experimental model of BS. Methods: We optically mapped electrical activity on the epicardial (n = 9) or transmural (n = 8) surface in 17 arterially perfused canine right ventricle preparations. Using pinacidil (5 μM) and pilsicainide (5 μM), we induced a model of BS that showed spontaneous VT. We then applied RFCA to the earliest activation site of premature ventricular complexes (PVCs) in the epicardium (EPI) or endocardium (ENDO) of the RV. Results: After induction of BS, the transmural electrocardiogram (ECG) showed BS-type ECG in association with prominent heterogeneity of action potential duration (APDs) within the EPI (APD: maximum 272 ± 39 ms, minimum 200 ± 39 ms, P < .01), but not within the ENDO. PVCs originated in the EPI region having short APDs and triggered functional reentry causing VT. Multiple epicardial foci of PVCs existed in each tissue (3.7 ± 1.9 foci/tissue). RFCA at the earliest activation site of PVCs in the EPI disconnected the short and long APD regions and eliminated all PVCs and VTs, although APD heterogeneity still existed. All successful RFCA lesions were confined to the EPI. RFCA in the ENDO failed to eliminate VT or PVCs. Conclusion: These experimental observations suggest that RFCA applied to the EPI may be more effective than applied to the ENDO in eliminating VT in patients with BS.

Original languageEnglish
Pages (from-to)665-671
Number of pages7
JournalHeart Rhythm
Volume6
Issue number5
DOIs
StatePublished - May 2009

Fingerprint

Brugada Syndrome
Catheter Ablation
Ventricular Tachycardia
Ventricular Premature Complexes
Pericardium
Cardiac Arrhythmias
Theoretical Models
Endocardium
Action Potentials
Electrocardiography
Pinacidil
Heart Ventricles
Canidae

Keywords

  • Brugada syndrome
  • Catheter ablation
  • Epicardium
  • Phase 2 reentry
  • Premature Ventricular complex
  • Ventricular fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Epicardial ablation eliminates ventricular arrhythmias in an experimental model of Brugada syndrome. / Morita, Hiroshi; Zipes, Douglas P.; Morita, Shiho T.; Lopshire, John C.; Wu, Jiashin.

In: Heart Rhythm, Vol. 6, No. 5, 05.2009, p. 665-671.

Research output: Contribution to journalArticle

Morita, Hiroshi ; Zipes, Douglas P. ; Morita, Shiho T. ; Lopshire, John C. ; Wu, Jiashin. / Epicardial ablation eliminates ventricular arrhythmias in an experimental model of Brugada syndrome. In: Heart Rhythm. 2009 ; Vol. 6, No. 5. pp. 665-671.
@article{75de3623a9014177a166c400045b0ab3,
title = "Epicardial ablation eliminates ventricular arrhythmias in an experimental model of Brugada syndrome",
abstract = "Background: Although radiofrequency catheter ablation (RFCA) has been used to treat patients with Brugada syndrome (BS), it is difficult to eliminate polymorphic ventricular tachycardias (VTs) completely. Objective: The purpose of this study was to determine the efficacy of RFCA in eliminating recurrent VTs in an experimental model of BS. Methods: We optically mapped electrical activity on the epicardial (n = 9) or transmural (n = 8) surface in 17 arterially perfused canine right ventricle preparations. Using pinacidil (5 μM) and pilsicainide (5 μM), we induced a model of BS that showed spontaneous VT. We then applied RFCA to the earliest activation site of premature ventricular complexes (PVCs) in the epicardium (EPI) or endocardium (ENDO) of the RV. Results: After induction of BS, the transmural electrocardiogram (ECG) showed BS-type ECG in association with prominent heterogeneity of action potential duration (APDs) within the EPI (APD: maximum 272 ± 39 ms, minimum 200 ± 39 ms, P < .01), but not within the ENDO. PVCs originated in the EPI region having short APDs and triggered functional reentry causing VT. Multiple epicardial foci of PVCs existed in each tissue (3.7 ± 1.9 foci/tissue). RFCA at the earliest activation site of PVCs in the EPI disconnected the short and long APD regions and eliminated all PVCs and VTs, although APD heterogeneity still existed. All successful RFCA lesions were confined to the EPI. RFCA in the ENDO failed to eliminate VT or PVCs. Conclusion: These experimental observations suggest that RFCA applied to the EPI may be more effective than applied to the ENDO in eliminating VT in patients with BS.",
keywords = "Brugada syndrome, Catheter ablation, Epicardium, Phase 2 reentry, Premature Ventricular complex, Ventricular fibrillation",
author = "Hiroshi Morita and Zipes, {Douglas P.} and Morita, {Shiho T.} and Lopshire, {John C.} and Jiashin Wu",
year = "2009",
month = "5",
doi = "10.1016/j.hrthm.2009.01.007",
language = "English",
volume = "6",
pages = "665--671",
journal = "Heart Rhythm",
issn = "1547-5271",
publisher = "Elsevier",
number = "5",

}

TY - JOUR

T1 - Epicardial ablation eliminates ventricular arrhythmias in an experimental model of Brugada syndrome

AU - Morita, Hiroshi

AU - Zipes, Douglas P.

AU - Morita, Shiho T.

AU - Lopshire, John C.

AU - Wu, Jiashin

PY - 2009/5

Y1 - 2009/5

N2 - Background: Although radiofrequency catheter ablation (RFCA) has been used to treat patients with Brugada syndrome (BS), it is difficult to eliminate polymorphic ventricular tachycardias (VTs) completely. Objective: The purpose of this study was to determine the efficacy of RFCA in eliminating recurrent VTs in an experimental model of BS. Methods: We optically mapped electrical activity on the epicardial (n = 9) or transmural (n = 8) surface in 17 arterially perfused canine right ventricle preparations. Using pinacidil (5 μM) and pilsicainide (5 μM), we induced a model of BS that showed spontaneous VT. We then applied RFCA to the earliest activation site of premature ventricular complexes (PVCs) in the epicardium (EPI) or endocardium (ENDO) of the RV. Results: After induction of BS, the transmural electrocardiogram (ECG) showed BS-type ECG in association with prominent heterogeneity of action potential duration (APDs) within the EPI (APD: maximum 272 ± 39 ms, minimum 200 ± 39 ms, P < .01), but not within the ENDO. PVCs originated in the EPI region having short APDs and triggered functional reentry causing VT. Multiple epicardial foci of PVCs existed in each tissue (3.7 ± 1.9 foci/tissue). RFCA at the earliest activation site of PVCs in the EPI disconnected the short and long APD regions and eliminated all PVCs and VTs, although APD heterogeneity still existed. All successful RFCA lesions were confined to the EPI. RFCA in the ENDO failed to eliminate VT or PVCs. Conclusion: These experimental observations suggest that RFCA applied to the EPI may be more effective than applied to the ENDO in eliminating VT in patients with BS.

AB - Background: Although radiofrequency catheter ablation (RFCA) has been used to treat patients with Brugada syndrome (BS), it is difficult to eliminate polymorphic ventricular tachycardias (VTs) completely. Objective: The purpose of this study was to determine the efficacy of RFCA in eliminating recurrent VTs in an experimental model of BS. Methods: We optically mapped electrical activity on the epicardial (n = 9) or transmural (n = 8) surface in 17 arterially perfused canine right ventricle preparations. Using pinacidil (5 μM) and pilsicainide (5 μM), we induced a model of BS that showed spontaneous VT. We then applied RFCA to the earliest activation site of premature ventricular complexes (PVCs) in the epicardium (EPI) or endocardium (ENDO) of the RV. Results: After induction of BS, the transmural electrocardiogram (ECG) showed BS-type ECG in association with prominent heterogeneity of action potential duration (APDs) within the EPI (APD: maximum 272 ± 39 ms, minimum 200 ± 39 ms, P < .01), but not within the ENDO. PVCs originated in the EPI region having short APDs and triggered functional reentry causing VT. Multiple epicardial foci of PVCs existed in each tissue (3.7 ± 1.9 foci/tissue). RFCA at the earliest activation site of PVCs in the EPI disconnected the short and long APD regions and eliminated all PVCs and VTs, although APD heterogeneity still existed. All successful RFCA lesions were confined to the EPI. RFCA in the ENDO failed to eliminate VT or PVCs. Conclusion: These experimental observations suggest that RFCA applied to the EPI may be more effective than applied to the ENDO in eliminating VT in patients with BS.

KW - Brugada syndrome

KW - Catheter ablation

KW - Epicardium

KW - Phase 2 reentry

KW - Premature Ventricular complex

KW - Ventricular fibrillation

UR - http://www.scopus.com/inward/record.url?scp=64649103289&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=64649103289&partnerID=8YFLogxK

U2 - 10.1016/j.hrthm.2009.01.007

DO - 10.1016/j.hrthm.2009.01.007

M3 - Article

C2 - 19328041

AN - SCOPUS:64649103289

VL - 6

SP - 665

EP - 671

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

IS - 5

ER -