{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T13:40:19Z","timestamp":1765546819431,"version":"3.37.3"},"reference-count":27,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2021,10,7]],"date-time":"2021-10-07T00:00:00Z","timestamp":1633564800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Microstructural abnormalities at the epicardium of the right ventricular outflow tract (RVOT) may provide the arrhythmia substrate in Brugada syndrome (BrS). Endocardial unipolar electroanatomical mapping allows the identification of epicardial abnormalities. We evaluated the clinical implications of an abnormal endocardial substrate as perceived by high\u2010density electroanatomical mapping (HDEAM) in patients with BrS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Fourteen high\u2010risk BrS patients with aborted sudden cardiac death (SCD) (12 males, mean age: 41.9\u2009\u00b1\u200911.8 years) underwent combined endocardial\u2010epicardial HDEAM of the right ventricle\/RVOT, while 40 asymptomatic patients (33 males, mean age: 42\u2009\u00b1\u200910.7 years) underwent endocardial HDEAM. Based on combined endocardial\u2010epicardial procedures, endocardial HDEAM was considered abnormal in the presence of low voltage areas (LVAs) more than 1\u2009cm<jats:sup>2<\/jats:sup> with bipolar signals less than 1\u2009mV and unipolar signals less than 5.3\u2009mV. Programmed ventricular stimulation (PVS) was performed in all patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The endocardial unipolar LVAs were colocalized with epicardial bipolar LVAs (<jats:italic>p<\/jats:italic>\u2009=\u2009.0027). Patients with aborted SCD exhibited significantly wider endocardial unipolar (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.01) and bipolar LVAs (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.01) compared with asymptomatic individuals. A substrate size of unipolar LVAs more than 14.5\u2009cm<jats:sup>2<\/jats:sup> (area under the curve [AUC]: 0.92, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001] and bipolar LVAs more than 3.68\u2009cm<jats:sup>2<\/jats:sup> (AUC: 0.82, <jats:italic>p<\/jats:italic>\u2009=\u2009.001) distinguished symptomatic from asymptomatic patients. Patients with ventricular fibrillation inducibility (23\/54) demonstrated broader endocardial unipolar (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) and bipolar LVAs (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) than noninducible patients. The presence of unipolar LVAs more than 13.5\u2009cm<jats:sup>2<\/jats:sup> (AUC: 0.95, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) and bipolar LVAs more than 2.97\u2009cm<jats:sup>2<\/jats:sup> (AUC: 0.78, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) predicted a positive PVS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Extensive endocardial electroanatomical abnormalities identify high\u2010risk patients with BrS. Endocardial HDEAM may allow risk stratification of asymptomatic patients referred for PVS.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.15262","type":"journal-article","created":{"date-parts":[[2021,10,2]],"date-time":"2021-10-02T12:14:45Z","timestamp":1633176885000},"page":"2997-3007","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Right ventricular outflow tract electroanatomical abnormalities in asymptomatic and high\u2010risk symptomatic patients with Brugada syndrome: Evidence for a new risk stratification tool?"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8924-8261","authenticated-orcid":false,"given":"Konstantinos P.","family":"Letsas","sequence":"first","affiliation":[{"name":"Second Department of Cardiology, Laboratory of Cardiac Electrophysiology \u201cEvangelismos\u201d General Hospital of Athens Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konstantinos","family":"Vlachos","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, Laboratory of Cardiac Electrophysiology \u201cEvangelismos\u201d General Hospital of Athens Athens Greece"},{"name":"H\u00f4pital Cardiologique du Haut\u2010L\u00e9v\u00eaque, CHU Bordeaux L'Institut de RYthmologie et Mod\u00e9lisation Cardiaque (LIRYC) Universit\u00e9 Bordeaux Bordeaux France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2248-3456","authenticated-orcid":false,"given":"Giulio","family":"Conte","sequence":"additional","affiliation":[{"name":"Cardiocentro Ticino Lugano Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Efremidis","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, Laboratory of Cardiac Electrophysiology \u201cEvangelismos\u201d General Hospital of Athens Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Nakashima","sequence":"additional","affiliation":[{"name":"H\u00f4pital Cardiologique du Haut\u2010L\u00e9v\u00eaque, CHU Bordeaux L'Institut de RYthmologie et Mod\u00e9lisation Cardiaque (LIRYC) Universit\u00e9 Bordeaux Bordeaux France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4367-1117","authenticated-orcid":false,"given":"Josselin","family":"Duchateau","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, Laboratory of Cardiac Electrophysiology \u201cEvangelismos\u201d General Hospital of Athens Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Bazoukis","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, Laboratory of Cardiac Electrophysiology \u201cEvangelismos\u201d General Hospital of Athens Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0372-4480","authenticated-orcid":false,"given":"Antonio","family":"Frontera","sequence":"additional","affiliation":[{"name":"H\u00f4pital Cardiologique du Haut\u2010L\u00e9v\u00eaque, CHU Bordeaux L'Institut de RYthmologie et Mod\u00e9lisation Cardiaque (LIRYC) Universit\u00e9 Bordeaux Bordeaux France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Panagiotis","family":"Mililis","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, Laboratory of Cardiac Electrophysiology \u201cEvangelismos\u201d General Hospital of Athens Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gary","family":"Tse","sequence":"additional","affiliation":[{"name":"Xiamen Cardiovascular Hospital Xiamen University Xiamen China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7305-311X","authenticated-orcid":false,"given":"Ghassen","family":"Cheniti","sequence":"additional","affiliation":[{"name":"H\u00f4pital Cardiologique du Haut\u2010L\u00e9v\u00eaque, CHU Bordeaux L'Institut de RYthmologie et Mod\u00e9lisation Cardiaque (LIRYC) Universit\u00e9 Bordeaux Bordeaux France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8473-7514","authenticated-orcid":false,"given":"Masateru","family":"Takigawa","sequence":"additional","affiliation":[{"name":"H\u00f4pital Cardiologique du Haut\u2010L\u00e9v\u00eaque, CHU Bordeaux L'Institut de RYthmologie et Mod\u00e9lisation Cardiaque (LIRYC) Universit\u00e9 Bordeaux Bordeaux 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