doi: 10.1161/CIRCULATIONAHA.105.532614
(Circulation. 2005;112:2769-2777.)
© 2005 American Heart Association, Inc.
Arrhythmia/Electrophysiology |
Right Ventricular Fibrosis and Conduction Delay in a Patient With Clinical Signs of Brugada Syndrome
A Combined Electrophysiological, Genetic, Histopathologic, and Computational Study
From the Experimental and Molecular Cardiology Group (R.C., S.C., T.T.K., A.O.V., J.R.d.G., C.R.B., M.W.V., A.C.L., H.L.T., A.A.M.W., J.M.T.d.B.) and the Departments of Clinical Genetics (Z.B., C.R.B.) and Cardiovascular Pathology (A.C.v.d.W.), Academic Medical Center, and the Interuniversity Cardiology Institute of the Netherlands (F.J.G.W.-S., J.M.T.d.B.), Amsterdam, the Netherlands, and the Cardiovascular Center (P.B.), OLV Hospital, Aalst, Belgium.
Correspondence to R. Coronel, MD, PhD, Department of Experimental Cardiology, Academic Medical Center, M0-108, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. E-mail r.coronel{at}amc.nl
Received December 28, 2004; revision received August 3, 2005; accepted August 8, 2005.
Background— The mechanism of ECG changes and arrhythmogenesis in Brugada syndrome (BS) patients is unknown.
Methods and Results— A BS patient without clinically detected cardiac structural abnormalities underwent cardiac transplantation for intolerable numbers of implantable cardioverter/defibrillator discharges. The patient’s explanted heart was studied electrophysiologically and histopathologically. Whole-cell currents were measured in HEK293 cells expressing wild-type or mutated sodium channels from the patient. The right ventricular outflow tract (RVOT) endocardium showed activation slowing and was the origin of ventricular fibrillation without a transmural repolarization gradient. Conduction restitution was abnormal in the RVOT but normal in the left ventricle. Right ventricular hypertrophy and fibrosis with epicardial fatty infiltration were present. HEK293 cells expressing a G1935S mutation in the gene encoding the cardiac sodium channel exhibited enhanced slow inactivation compared with wild-type channels. Computer simulations demonstrated that conduction slowing in the RVOT might have been the cause of the ECG changes.
Conclusions— In this patient with BS, conduction slowing based on interstitial fibrosis, but not transmural repolarization differences, caused the ECG signs and was the origin of ventricular fibrillation.
Key Words: arrhythmia • ion channels • genes • repolarization • conduction
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