IMR Press / RCM / Volume 23 / Issue 2 / DOI: 10.31083/j.rcm2302044
Open Access Review
Right ventricular outflow tract endocardial unipolar substrate mapping: implications in risk stratification of Brugada syndrome
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1 Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
2 Department of Cardiology, University of Ioannina Medical School, 45110 Ioannina, Greece
3 Kent and Medway Medical School, CT2 7FS Canterbury, UK
4 Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, 300211 Tianjin, China
5 Department of Cardiology, Medical School, University of Nicosia, 2408 Nicosia, Cyprus
6 Department of Cardiology, Larnaca General Hospital, 7036 Larnaca, Cyprus
7 Second Department of Cardiology, Evangelismos General Hospital of Athens, 10676 Athens, Greece
8 Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), 33600 Bordeaux, France
9 Division of Cardiology, Queen's University, Kingston General Hospital, Kingston, K7K Ontario, Canada
*Correspondence:; (Konstantinos P. Letsas)
Academic Editor: Peter A. McCullough
Rev. Cardiovasc. Med. 2022, 23(2), 44;
Submitted: 12 October 2021 | Revised: 29 December 2021 | Accepted: 8 January 2022 | Published: 25 January 2022
(This article belongs to the Special Issue Catheter Ablation of Ventricular Tachycardia)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Brugada syndrome (BrS) is a complex arrhythmogenic disease displaying electrical and micro-structural abnormalities mainly located at the epicardium of the right ventricular outflow tract (RVOT). It is well-known that fibrosis, fatty infiltration, inflammation and reduced gap junction expression have been demonstrated at the epicardial anterior aspect of the RVOT providing the arrhythmogenic substrate for ventricular arrhythmic events in BrS. A number of models have been proposed for the risk stratification of patients with BrS. Endocardial unipolar electroanatomical mapping is an emerging tool that has been reintroduced to identify and quantify epicardial electrical abnormalities. Interestingly, current findings correlate the presence of large-sized endocardial unipolar electroanatomical abnormalities with either ventricular fibrillation inducibility during programmed ventricular stimulation or symptom status. This review aims to present existing data about the role of endocardial unipolar electroanatomical mapping for the identification of RVOT epicardial abnormalities as well as its potential clinical implications in risk stratification of BrS.

Brugada syndrome
Electroanatomical mapping
Risk stratification
Fig. 1.
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