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CLINICAL STUDY: ELECTROPHYSIOLOGY

Assessment of noninvasive markers in identifying patients at risk in the brugada syndrome: insight into risk stratification

Takanori Ikeda, MD, FACC^*, Harumizu Sakurada, MD, Koichi Sakabe, MD^*, Takao Sakata, MD^*, Mitsuaki Takami, MD^*, Naoki Tezuka, MD^*, Takeshi Nakae, MD^*, Mahito Noro, MD^*, Yoshihisa Enjoji, MD^*, Tamotsu Tejima, MD, Kaoru Sugi, MD^* and Tetsu Yamaguchi, MD^*

^* Third Department of Internal Medicine, Ohashi Hospital, Toho University School of Medicine, Tokyo, Japan
Division of Cardiology, Tokyo Metropolitan Hiroo General Hospital, Tokyo, Japan

Manuscript received June 5, 2000; revised manuscript received October 5, 2000, accepted January 12, 2001.

Reprint requests and correspondence: Dr. Takanori Ikeda, Third Department of Internal Medicine, Ohashi Hospital, Toho University School of Medicine, 2-17-6 Ohashi, Meguro, Tokyo 153-8515, Japan
iket{at}oha.toho-u.ac.jp

OBJECTIVES

The aim of this study was to compare the use of various noninvasive markers for detecting risk of life-threatening arrhythmic events in patients with Brugada syndrome.

BACKGROUND

The role of conduction disturbance in arrhythmogenesis of the syndrome is controversial, whereas it is well established that repolarization abnormalities are responsible for arrhythmias. The value of noninvasive markers reflecting conduction or repolarization abnormalities in identifying patients at risk for significant arrhythmias has not been shown.

METHODS

We assessed late potentials (LP) using signal-averaged electrocardiography (ECG), microvolt T-wave alternans (TWA), and corrected QT-interval dispersion (QTD) in 44 consecutive patients who had ECGs showing a pattern of right bundle branch block and ST-segment elevation in leads V₁ to V₃ but structurally normal hearts. The patients were compared with 30 normal individuals.

RESULTS

Eleven patients were excluded from data analysis because of an absence of ECG manifestations of Brugada syndrome at the time of the tests. A history of life-threatening events defined as syncope and aborted sudden death was present in 19 of 33 patients (58%); in 15 of the 19 patients, stimulation induced ventricular fibrillation or polymorphic ventricular tachycardia. The LP were present in 24 of 33 patients (73%); TWA were present in 5 of 31 patients (16%); and a QTD >50 ms was present in 9 of 33 patients (27%). The incidence of LP in Brugada patients was significantly (p < 0.0001) higher than in the controls, whereas incidences of TWA and QTD were not significantly different. Multivariate logistic regression analysis revealed that the presence of LP had the most significant correlation to the occurrence of life-threatening events (p = 0.006).

CONCLUSIONS

Late potentials are a noninvasive risk stratifier in patients with Brugada syndrome. These results may support the idea that conduction disturbance per se is arrhythmogenic.

Abbreviations and Acronyms   ECG = electrocardiography   f-QRS = filtered QRS duration   LAS40 = duration of low-amplitude signals <40 µV in the terminal filtered QRS complex   LP = late potentials   QTc = corrected QT interval   QTD = corrected QT-interval dispersion   RBBB = right bundle branch block   RMS40 = root mean square voltage of the terminal 40 ms in the filtered QRS complex   TWA = T-wave alternans   VF = ventricular fibrillation   VM = vector magnitude   VT = ventricular tachycardia

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