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Recording of isolated very delayed potentials on the right ventricular epicardium in a patient with Brugada syndrome  Atsuyuki Watanabe, MD, Hiroshi Morita,

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Presentation on theme: "Recording of isolated very delayed potentials on the right ventricular epicardium in a patient with Brugada syndrome  Atsuyuki Watanabe, MD, Hiroshi Morita,"— Presentation transcript:

1 Recording of isolated very delayed potentials on the right ventricular epicardium in a patient with Brugada syndrome  Atsuyuki Watanabe, MD, Hiroshi Morita, MD, Sho Tsushima, MD, Koji Nakagawa, MD, Nobuhiro Nishii, MD, Hiroshi Ito, MD  HeartRhythm Case Reports  Volume 3, Issue 7, Pages (July 2017) DOI: /j.hrcr Copyright © 2017 Heart Rhythm Society Terms and Conditions

2 Figure 1 A: Left panel: Twelve-lead electrocardiogram (ECG) showing sinus rhythm and typical coved-type pattern with Brugada syndrome. Right panel: The ST elevation of V1 and V2 lead was reduced after the ablation. B: Multiple abnormal potentials were found on the epicardium at the right ventricular outflow tract: (a) high-voltage + low-frequency delayed potential, (b) double potential, (c) high voltage + fragmentation, (d) low voltage + fragmentation. HeartRhythm Case Reports 2017 3, DOI: ( /j.hrcr ) Copyright © 2017 Heart Rhythm Society Terms and Conditions

3 Figure 2 Isolated very delayed potentials (IVDPs) on the epicardial right ventricular outflow tract (RVOT). IVDPs appeared 400–500 ms after the last ventricular activation captured by the extrastimuli. The IVDPs were discrete low-voltage potentials with 1–3 sharp spikes, and there were no electrical activities between the last ventricular activation by extrastimuli and IVDPs. This potential appeared by ventricular pacing and did not reflect any potential on the body-surface electrocardiogram. HeartRhythm Case Reports 2017 3, DOI: ( /j.hrcr ) Copyright © 2017 Heart Rhythm Society Terms and Conditions

4 Figure 3 Unusual response of the isolated very delayed potentials (IVDPs) to ventricular pacing. Shortening of the S2-S3 interval abbreviated very delayed potential, but its interval was prolonged. Interestingly, the interval between S3 pacing of 400/290/230 to the isolated potential was almost the same as the interval between the local fragmented ventricular potential to the delayed potential at 400/290/210 pacing. Pacing site = right ventricular epicardium. HeartRhythm Case Reports 2017 3, DOI: ( /j.hrcr ) Copyright © 2017 Heart Rhythm Society Terms and Conditions

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