Abstract
BackgroundSodium channel blockers augment ST-segment elevation in the right precordial leads in patients undergoing Brugada-type electrocardiography (ECG). However, their effect on echocardiographic features is not known. We address this by assessing global and regional ventricular function using conventional Doppler and two- dimensional (2D) speckle tracking techniques.MethodsThirty-one patients with Brugada-type ECG were studied. A pure sodium channel blocker, pilsicainide, was used to provoke an ECG response. The percentage longitudinal systolic myocardial strain at the base of both the right ventricular (RV) free wall and the interventricular septum wall was measured using 2D speckle tracking. Left ventricular (LV) and RV myocardial performance (TEI) indices were also measured.ResultsThe pilsicainide challenge provoked a positive ECG response in 13 patients (inducible group). In the inducible group, longitudinal strain was significantly reduced only at the RV (-27.3 ± 5.4% vs -22.1 ± 3.6%, P < 0.01), and both RV and LV TEI indices increased (RV: 0.19 ± 0.09 vs 0.27 ± 0.11, P < 0.05; LV: 0.30 ± 0.10 vs 0.45 ± 0.10, P < 0.01) after pilsicainide administration.ConclusionsTemporal and spatial analysis using the TEI index and 2D strain imaging revealed the deterioration of global ventricular function associated with conduction disturbance and RV regional function in patients with Brugada-type ECG and coved type ST elevation due to administration of a sodium channel blocker.
Highlights
Sodium channel blockers augment ST-segment elevation in the right precordial leads in patients undergoing Brugada-type electrocardiography (ECG)
A previous study demonstrated that a sodium channel blocker, flecainide, induced a delay in right ventricular (RV) activation in patients with Brugada syndrome, using tissue Doppler imaging (TDI) [6]
We aim to evaluate the echocardiographic characteristics in patients with Brugada-like ECG using 2D strain imaging and the TEI index, and to clarify whether or not changes in these indices occur according to the ECG response to a sodium channel blocker
Summary
Sodium channel blockers augment ST-segment elevation in the right precordial leads in patients undergoing Brugada-type electrocardiography (ECG) Their effect on echocardiographic features is not known. We address this by assessing global and regional ventricular function using conventional Doppler and twodimensional (2D) speckle tracking techniques. Brugada syndrome is characterized by ST-segment elevation in right precordial leads and electrolyte disturbances associated with a high risk of cardiac sudden death [1]. Despite these ST-segment changes in the ECG in this syndrome, no structural abnormalities have been detected by conventional echocardiography. A myocardial performance index (the TEI index) derived by temporal analysis of the Doppler in- and outflow of the ventricle has been accepted as a global ventricular functional index affected by ventricular activation [9]
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