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Mode of onset of ventricular fibrillation in patients with Brugada syndrome detected by implantable cardioverter defibrillator therapy

Mikio Kakishita, MD^{* c}, Takashi Kurita, MD^c, Kiyotaka Matsuo, MD^c, Atsushi Taguchi, MD, Kazuhiro Suyama, MD, Wataru Shimizu, MD, Naohiko Aihara, MD, Shiro Kamakura, MD, Fumio Yamamoto, MD^c, Junjiro Kobayashi, MD^c, Yoshio Kosakai, MD^c and Tohru Ohe, MD, FACC^{* c}

^* Department of Cardiology, Okayama University Medical School, Okayama, Japan
Department of Anatomy, Okayama University Medical School, Okayama, Japan
^c Division of Cardiology, National Cardiovascular Center, Osaka, Japan
Department of Internal Medicine, National Cardiovascular Center, Osaka, Japan
Department of Surgery, National Cardiovascular Center, Osaka, Japan

View larger version (10K): [in a new window]   Figure 1 Twelve-lead electrocardiogram of Patient 4 with Brugada syndrome during sinus rhythm. An incomplete right bundle branch block and ST segment elevation with a coved type in leads V1 and V2 were observed.

View larger version (16K): [in a new window]   Figure 2 Event-free survival rate after ICD implantation for all 19 patients (Kaplan–Meier method). The number at the bottom of graph indicates the number of patients at risk at each time point.

View larger version (24K): [in a new window]   Figure 3 Stored intracardiac electrograms of the initiation of VF obtained from Patients 1, 2 and 3 with implantation of Ventak PRX-II. All VF episodes were preceded by the PVCs (asterisk), which were almost identical to the initiating beats of VF. Only Patient 1 demonstrated long-short R-R sequences before the onset of VF.

View larger version (45K): [in a new window]   Figure 4 Stored intracardiac electrograms from Patient 4, with Micro Jewel II and ECG monitoring of Patient 5 with Ventak P at the initiation of VF. As in Figure 2, all VF episodes were preceded by the PVCs (asterisk), which were almost identical to the initiating beats of VF.

View larger version (23K): [in a new window]   Figure 5 Stored intracardiac electrograms at the onset of VF obtained from Patient 1 with Ventak PRX-II. A total of 23 episodes of VF occurred within several years. Three episodes are presented. Ventricular fibrillation episodes were initiated by the PVC (asterisk), with the same pattern of QRS morphology.

View larger version (23K): [in a new window]   Figure 6 Stored intracardiac electrograms at the onset of VF obtained from Patient 2 with Ventak PRX-II. Frequent PVCs were seen before the onset of VF on January 23, 1996, but not during the other episodes. Preceding PVCs (asterisk) and initiating PVCs (arrow) show the similar QRS morphology.