Brugada症候群における心電図変化と局所再分極異常との対応 : コンピュータシミュレーションによる理論的解析

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Brugada and Brugada reported the right bundle branch block (RBBB)-like QRS waveform and ST segment elevation in the right precordial leads of the electrocardiogram as a new subtype of idiopathic ventricular fibrillation (Brugada syndrome), which has gained much attention as a cause of the sudden cardiac death. The abnormal repolarization in the right ventricular epicardium, which is the increased phase 1 notch and/or the depressed phase 2-3 dome in the action potential configuration, has been proposed as the mechanism of this syndrome. The functional reentrant activation, which is a cause of cardiac fibrillation, has been reported to be inducible in a sliced right ventricular epicardium with a cluster of the abnormal repolarization. In this study, we evaluated the relation between the abnormal repolarization placed in the given region of the right ventricular epicardium and the electrocardiographic changes in the right precordial leads by using computer simulation. The simulation was conducted on the 2-dimensional excitable array corresponding to a thin sliced right ventricular epicardium. The abnormal repolarization processes were placed as a cluster in the center of the array. The array was constantly stimulated at 1000msec of cycle length. In the unipolar potential calculated at the point of 5mm over the center of the array, which was corresponding to the right precordial leads of the electrocardiogram, the greater the phase 1 notch was increased, the closer to the RBBB the QRS waveform revealed. On the other hand, the greater the phase 2-3 dome was depressed, the higher the ST segment was elevated. Our results suggested that the repolarization abnormalities in the given region of the right ventricular epicardium would be a possible mechanism of the Brugada syndrome. Furthermore, our results clarified the relation between the pattern of the abnormal repolarization process and the characteristic electrocardiographic changes of this syndrome.
香川県立保健医療大学の論文

Brugada症候群における心電図変化と局所再分極異常との対応 : コンピュータシミュレーションによる理論的解析

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