Abstract 14047: Novel Noninvasive Risk Stratification Method Using Control-and-stability-theory Applied to 12-lead-ECG Repolarization Patterns in Brugada Type1 Subjects

Abstract

Background: Brugada syndrome (BrS) risk stratification in asymptomatic subjects and its underlying pathophysiological dynamics is complex. Purpose: This study aims to analyze, from alternative standpoints, superficial 12-lead ECG V2 repolarization patterns (repol.). This method diverges from ECG pattern characterization (patterns, angles, shapes, intervals, waves); it rather exploits nonlinear dynamics and stability of ECG repol. to assess stability driving cardiac dynamics: basal, after flecainide, during RF ablation, after 2nd flecainide test and post procedure. Target: to lower the number of invasive electrophysiology studies, furthering knowledge and applications of control-and-stability-theory applied to ECG. Methods: A stability control closed loop system has been designed to model electrophysiology dynamics of cardiac conduction: ECG segments being the input-output of the system. (Figure). A sequence of V2 repol. have been scanned, digitized and quantitatively processed yielding stability parameters (poles in S-plane). Scanning by Digitizeit - Digital River GmbH. S-plane computation by Microsoft Office, Wolfram Demonstrations Project & Contributors, https://demonstrations.wolfram.com Results: Figure. Conclusions: Based on our data, 1) 12-lead-ECG repol. are associated with increasing stability (parameter values b), denoting underlying nonlinear dynamics, trending to incremental stability from basal to end of procedure.2) The incremental stability associated with all the process phases, from basal to end of procedure, indicates a potential use of this methodology to BrS risk stratification. Unstable repol. may be classified as high VT risk. In conclusion, furthering control-and-stability-theory applied to 12-lead ECGs aims to deeper comprehension of physiological and pathological substrates of malignant arrhythmias, and to focus on noninvasive risk stratification strategies for ICD implantation indication in BrS.