“For a handful of cells”. One has to say it, paraphrasing the title of a famous western, in reference to the heart. Because there is a control unit, invisible but traceable thanks to a medicine that acts as a “spy”, capable of triggering ventricular fibrillation in those suffering from Brugada. It is located on the surface of the heart, i.e. on the epicardium. It was defined as an arrhythmic substrate and was identified by the research group of Carlo Pappone, Director of the Electrophysiology and Arrhythmology Operational Unit of the Irccs Policlinico San Donato. That group of cells capable of expressing anomalous electrical potentials forms an area that is associated with the clinical presentation of the disease and the risk of suffering from a more aggressive form of disease, that associated with the development of malignant ventricular arrhythmias, which put you at risk of cardiac arrest.
One more step in research
Today the research takes a step further. Because not only does it demonstrate once again the role of this invisible cellular structure, but it also shows that by “silencing” those very cells with a tailor-made treatment, epicardial ablation with radiofrequency, a potential stable and lasting of the situation. The treatment, in fact, proves that it can eliminate the anomalous electrical signals that arise precisely on the cardiac surface. Not only. The role of a pharmacological “explorer” of the heart wall is also confirmed. It is called aimalina and allows latent electrical anomalies to be de-identified, thus paving the way for providing targeted treatment with radio frequencies. What offers all this information and outlines important future prospects for this pathology is research by the same group (Carlo Pappone, Giuseppe Ciconte, Gabriele Vicedomini, Luigi Anastasia and Vincenzo Santinelli) of the same Department of Arrhythmology, which appeared in the journal EP Europace.
Injectable gel plus pacemaker, thus we will reduce the risk of ventricular fibrillation after a heart attack by Federico Mereta 29 January 2024
What the research says
The study examined 257 patients with symptomatic Brugada Syndrome in whom a defibrillator was implanted. 206 underwent epicardial radiofrequency ablation, while a second group of 51 patients received only the implantation of the defibrillator and refused ablation. In the group treated with ablation, we obviously first proceeded to identify the “anomalous control units” to be treated on the surface of the epicardium of the right ventricle, using the research strategies described above. Before treatment, with a median observation of approximately 27 months, episodes of fibrillation were recorded in 53 patients. In the monitoring period (40 months) following ablation, however, the group subjected to this therapy showed superior results compared to the control group. All of this, it must be remembered, without any significant complications related to the procedure. The study, therefore, gives hope that the ablation of Brugada Syndrome can free patients from a disease that can threaten their lives every day. Furthermore, it cannot be ruled out in the near future that this therapeutic technique could represent a valid alternative to the implantation of a defibrillator, which obviously, despite being a lifesaver, can have serious influences on everyday life. The ongoing studies, some of which are close to publication, are awaited for further confirmation.
Wearable defibrillator, when needed for those at risk of cardiac arrest by Federico Mereta 29 May 2023
What is Brugada syndrome
The disease has genetic origin and can cause various forms of arrhythmias. It is called so by the discoverers of the painting, Josep and Pedro Brugada. The pathology can lead to malignant ventricular fibrillation which also appears in young people and adolescents, with a consequent increased risk of sudden death. Arrhythmias can begin at any age, although they occur more frequently during adulthood, between the ages of 25 and 45. What happens when ventricular fibrillation is triggered in a person with the condition? the left ventricle contracts hundreds of times a minute in a completely independent manner compared to the atrium above, which instead maintains its normal rhythm. This hemodynamic situation quickly leads to a disruption in blood circulation. In fact, the “crazy” contractions of the ventricle are completely useless, because each time the blood introduced into the aorta is far less than the body’s needs. In a few seconds, therefore, a serious state can occur ischemia to the heart itself, the brain and other organs.
Heart door The defibrillator saves lives, even if help is on the way by Federico Mereta 24 August 2023