Incremental Pacing Induces Sustained Reentry in a Computational Model of Brugada Syndrome

Brugada Syndrome is a form of idiopathic ventricular fibrillation. To date, there is no definitive theory about how ventricular fibrillation is initiated, or a consensus on its substrate. In this work, we report a computational study aimed at determining the role of the pacing protocol on the induction of sustained arrhythmias in Brugada Syndrome. We developed a computational model of Brugada Syndrome, including both structural and electrophysiological abnormalities in a slab of transmurally heterogeneous cardiac tissue. Starting from the clinical observation that cardiac episodes are more frequent at rest, we studied the effect of incremental pacing (i.e., with increasing pacing cycle length) on the generation of reentrant activity. Our results suggest that incremental pacing can unmask the arrhythmogenic substrate of Brugada Syndrome.