Abstract 2910: Longitudinal Myocardial Strain in Right Ventricular Wall Reduced by Pilsicainide Challenge in Patients with Brugada Type Electrocardiography -Evaluation by Two-Dimensional Strain Imaging Technique
Background: Tissue Doppler imaging revealed that pure sodium channel blocker, pilsicainide (PIL) provoked right ventricular activation delay in Brugada syndrome. However, the effect of PIL on regional myocardial systolic function in Brugada syndrome is unknown.
Method: Thirty patients with Brugada type ECG were studied. PIL was infused (1mg/kg; i.v. over 10 minutes) to provoke a ECG response. Before and after PIL, apical 4-chamber view was recorded. Two dimensional (2D) strain imaging based on speckle tracking techinique was used to obtain longitudinal myocardial strain (%) at both the base of interventricular septum (IVS) and right ventricular free wall (RV).
Results: Patients were subdivided into three groups according to their ECG response. Nine of 30 patients had persistent coved type ST-elevation (baseline positive) and 7 had a positive ECG response provoked by PIL (type 1, coved type; inducible), and 14 had a negative ECG response (negative). Before PIL, there were no differences in longitudinal myocardial strain at both IVS and RV among 3 groups. After PIL infusion, peak longitudinal strain at RV in both baseline positive and inducible group were depressed (−26.4 ± 6.2 to −21.9 ± 5.1, −26.2 ± 3.9 to −21.5 ± 3.9, both p < 0.05, respectively). However, longitudinal strain at RV in negative group and at IVS among 3 groups had no change before and after PIL.
Conclusion: 2D-strain imaging revealed depressed RV regional systolic function in patients with Brugada type ECG and positive response by PIL challenge.