{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T13:24:05Z","timestamp":1792416245069,"version":"4.4.0"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2015,12]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Brugada syndrome (BrS) is characterized by a typical ECG pattern. We aimed to determine the pathophysiologic basis of the ST-segment in the BrS-ECG with data from various epicardial and endocardial right ventricular activation mapping procedures in 6 BrS patients and in 5 non-BrS controls.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>In 7 patients (2 BrS and 5 controls) with atrial fibrillation, an epicardial 8\u00d76 electrode grid (interelectrode distance 1 mm) was placed epicardially on the right ventricular outflow tract (RVOT) before video-assisted thoracoscopic surgical pulmonary vein isolation. In 2 other BrS patients, endocardial, epicardial RV (CARTO), and body surface mapping was performed. In 2 additional BrS patients, we performed decremental preexcitation of the RVOT before endocardial RV mapping. During video-assisted thoracoscopic surgical pulmonary vein isolation and CARTO mapping, BrS patients (n=4) showed greater activation delay and more fractionated electrograms in the RVOT region than controls. Ajmaline administration increased the region with fractionated electrograms, as well as ST-segment elevation. Preexcitation of the RVOT (n=2) resulted in ECGs that supported the current-to-load mismatch hypothesis for ST-segment elevation. Body surface mapping showed that the area with ST-segment elevation anatomically correlated with the area of fractionated electrograms and activation delay at the RVOT epicardium.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>ST-segment elevation and epicardial fractionation\/conduction delay in BrS patients are most likely related to the same structural subepicardial abnormalities, but the mechanism is different. ST-segment elevation may be caused by current-to-load mismatch, whereas fractionated electrograms and conduction delay are expected to be caused by discontinuous conduction in the same area with abnormal myocardium.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circep.115.003366","type":"journal-article","created":{"date-parts":[[2015,10,20]],"date-time":"2015-10-20T04:35:34Z","timestamp":1445315734000},"page":"1382-1392","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":49,"title":["ST-Segment Elevation and Fractionated Electrograms in Brugada Syndrome Patients Arise From the Same Structurally Abnormal Subepicardial RVOT Area but Have a Different Mechanism"],"prefix":"10.1161","volume":"8","author":[{"given":"Judith N.","family":"ten Sande","sequence":"first","affiliation":[{"name":"From the Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam (J.N.t.S., R.C., C.E.C., A.H.G.D., J.R.d.G., H.L.T., A.A.M.W., J.M.T.d.B., P.F.H.M.v.D.); Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands (J.N.t.S., J.M.T.d.B.); L\u2019Institut de RYthmologie et de mod\u00e9lisation Cardiaque (LIRYC), Universit\u00e9 Bordeaux Segalen, Bordeaux, France (R.C.); and Pacific Rim Electrophysiology Research Institute,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruben","family":"Coronel","sequence":"additional","affiliation":[{"name":"From the Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam (J.N.t.S., R.C., C.E.C., A.H.G.D., J.R.d.G., H.L.T., A.A.M.W., J.M.T.d.B., P.F.H.M.v.D.); Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands (J.N.t.S., J.M.T.d.B.); L\u2019Institut de RYthmologie et de mod\u00e9lisation Cardiaque (LIRYC), Universit\u00e9 Bordeaux Segalen, Bordeaux, France (R.C.); and Pacific Rim Electrophysiology Research Institute,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantal E.","family":"Conrath","sequence":"additional","affiliation":[{"name":"From the Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam (J.N.t.S., R.C., C.E.C., A.H.G.D., J.R.d.G., H.L.T., A.A.M.W., J.M.T.d.B., P.F.H.M.v.D.); Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands (J.N.t.S., J.M.T.d.B.); L\u2019Institut de RYthmologie et de mod\u00e9lisation Cardiaque (LIRYC), Universit\u00e9 Bordeaux Segalen, Bordeaux, France (R.C.); and Pacific Rim Electrophysiology Research Institute,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoine H.G.","family":"Driessen","sequence":"additional","affiliation":[{"name":"From the Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam (J.N.t.S., R.C., C.E.C., A.H.G.D., J.R.d.G., H.L.T., A.A.M.W., J.M.T.d.B., P.F.H.M.v.D.); Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands (J.N.t.S., J.M.T.d.B.); L\u2019Institut de RYthmologie et de mod\u00e9lisation Cardiaque (LIRYC), Universit\u00e9 Bordeaux Segalen, Bordeaux, France (R.C.); and Pacific Rim Electrophysiology Research Institute,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joris R.","family":"de Groot","sequence":"additional","affiliation":[{"name":"From the Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam (J.N.t.S., R.C., C.E.C., A.H.G.D., J.R.d.G., H.L.T., A.A.M.W., J.M.T.d.B., P.F.H.M.v.D.); Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands (J.N.t.S., J.M.T.d.B.); L\u2019Institut de RYthmologie et de mod\u00e9lisation Cardiaque (LIRYC), Universit\u00e9 Bordeaux Segalen, Bordeaux, France (R.C.); and Pacific Rim Electrophysiology Research Institute,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanno L.","family":"Tan","sequence":"additional","affiliation":[{"name":"From the Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam (J.N.t.S., R.C., C.E.C., A.H.G.D., J.R.d.G., H.L.T., A.A.M.W., J.M.T.d.B., P.F.H.M.v.D.); Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands (J.N.t.S., J.M.T.d.B.); L\u2019Institut de RYthmologie et de mod\u00e9lisation Cardiaque (LIRYC), Universit\u00e9 Bordeaux Segalen, Bordeaux, France (R.C.); and Pacific Rim Electrophysiology Research Institute,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koonlawee","family":"Nademanee","sequence":"additional","affiliation":[{"name":"From the Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam (J.N.t.S., R.C., C.E.C., A.H.G.D., J.R.d.G., H.L.T., A.A.M.W., J.M.T.d.B., P.F.H.M.v.D.); Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands (J.N.t.S., J.M.T.d.B.); L\u2019Institut de RYthmologie et de mod\u00e9lisation Cardiaque (LIRYC), Universit\u00e9 Bordeaux Segalen, Bordeaux, France (R.C.); and Pacific Rim Electrophysiology Research Institute,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur A.M.","family":"Wilde","sequence":"additional","affiliation":[{"name":"From the Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam (J.N.t.S., R.C., C.E.C., A.H.G.D., J.R.d.G., H.L.T., A.A.M.W., J.M.T.d.B., P.F.H.M.v.D.); Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands (J.N.t.S., J.M.T.d.B.); L\u2019Institut de RYthmologie et de mod\u00e9lisation Cardiaque (LIRYC), Universit\u00e9 Bordeaux Segalen, Bordeaux, France (R.C.); and Pacific Rim Electrophysiology Research Institute,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques M.T.","family":"de Bakker","sequence":"additional","affiliation":[{"name":"From the Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam (J.N.t.S., R.C., C.E.C., A.H.G.D., J.R.d.G., H.L.T., A.A.M.W., J.M.T.d.B., P.F.H.M.v.D.); Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands (J.N.t.S., J.M.T.d.B.); L\u2019Institut de RYthmologie et de mod\u00e9lisation Cardiaque (LIRYC), Universit\u00e9 Bordeaux Segalen, Bordeaux, France (R.C.); and Pacific Rim Electrophysiology Research Institute,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal F.H.M.","family":"van Dessel","sequence":"additional","affiliation":[{"name":"From the Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam (J.N.t.S., R.C., C.E.C., A.H.G.D., J.R.d.G., H.L.T., A.A.M.W., J.M.T.d.B., P.F.H.M.v.D.); Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands (J.N.t.S., J.M.T.d.B.); L\u2019Institut de RYthmologie et de mod\u00e9lisation Cardiaque (LIRYC), Universit\u00e9 Bordeaux Segalen, Bordeaux, France (R.C.); and Pacific Rim Electrophysiology Research Institute,..."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000152479.54298.51"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(92)90253-J"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2013.07.021"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.95.9.2277"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.1998.tb01843.x"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.102.20.2509"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(02)01962-9"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.111.964577"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.103.5.710"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.532614"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.520999"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.972612"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardiores.2005.03.005"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.110.937029"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.yjmcc.2010.07.012"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2009.10.007"},{"issue":"2","key":"e_1_3_4_18_2","first-page":"H548","article-title":"I(to) and action potential notch are smaller in left vs. right canine ventricular epicardium.","volume":"271","author":"Di Diego JM","year":"1996","unstructured":"Di Diego JM, Sun ZQ, Antzelevitch C. 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