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Atrial fibrillation and atrial vulnerability in patients with Brugada syndrome

Hiroshi Morita, MD^*,*, Kengo Kusano-Fukushima, MD^*, Satoshi Nagase, MD^*, Yoshihisa Fujimoto, MD, Kenichi Hisamatsu, MD^*, Hideki Fujio, MD^*, Kayo Haraoka, MD^*, Makoto Kobayashi, MD^*, Shiho Takenaka Morita, MD^*, Kazufumi Nakamura, MD^*, Tetsuro Emori, MD^*, Hiromi Matsubara, MD^*, Kazumasa Hina, MD, Toshimasa Kita, MD, Masahiko Fukatani, MD and Tohru Ohe, MD^*

^* Department of Cardiovascular Medicine, Okayama University Graduate School, Okayama, Japan
Department of Cardiovascular Medicine, Fukuyama Cardiovascular Hospital, Fukuyama, Japan
Department of Cardiovascular Medicine, Cardiovascular Center Sakakibara Hospital, Okayama, Japan
Department of Cardiovascular Medicine, Hata Kennmin Hospital, Sukumo, Japan

View larger version (45K): [in a new window]   Figure 1 Initiation of spontaneous atrial fibrillation (AF) on the Holter ambulatory electrocardiogram. (a) Spontaneous AF occurred at midnight. Premature atrial contraction was not observed before the occurrence of AF. (b) Initiation of paroxysmal AF. Paroxysmal atrial contraction occurred on the T-wave at the initiation of AF. Coarse fibrillatory waves succeeded and degenerated into fine and irregular f waves.

View larger version (72K): [in a new window]   Figure 2 Spontaneous atrial fibrillation (AF) in patients with Brugada syndrome. Note the slower ventricular response during AF. Lead V2 is shown.

View larger version (18K): [in a new window]   Figure 3 Effective refractory period of the atrioventricular node (a) and right atrium (RA) (b). (a) The effective refractory period (ERP) of atrioventricular node was prolonged in the Brugada syndrome patients with and without atrial fibrillation (AF). (b) There was no significant difference between the ERP of the RA in the Brugada syndrome group and that in the control group. There was also no significant difference between the ERP of the RA in the Brugada syndrome patients without AF and that in the control group. Open circles show the Brugada syndrome group with spontaneous AF. Solid circles show the Brugada syndrome patients without spontaneous AF. The error bars represent the 95% confidence interval. NS = not significant.

View larger version (17K): [in a new window]   Figure 4 (a) Conduction time (CT) at S1 and (b) CT at S2. There was no difference between the CT at S1 in patients with Brugada syndrome and that in the control group, but the CT at S2 in the Brugada syndrome group was markedly delayed at the right atrium-effective refractory period. The CT1 in the Brugada syndrome patients without atrial fibrillation (AF) was not different from that in the control group, but the CT2 in these Brugada syndrome patients was prolonged. (c) Inter-atrial conduction delay. The conduction delay (CD) was markedly prolonged in the Brugada syndrome group, and all patients with Brugada syndrome showed a positive CD. The CD was also prolonged in the Brugada syndrome patients without AF. Open circles show the Brugada syndrome patients with spontaneous AF. Solid circles show the Brugada syndrome patients without spontaneous AF. The error bars represent the 95% confidence interval.

View larger version (15K): [in a new window]   Figure 5 Duration of atrial potential and fragmented atrial activity (FAA). (a) Duration of A1. There was no difference between the duration of A1 in patients with Brugada syndrome and that in the control group. (b) Duration of A2. The duration of A2 in Brugada syndrome was markedly prolonged compared with that in the control group. The duration of A2 was also markedly prolonged in Brugada syndrome patients without atrial fibrillation (AF). (c) FAA. The ratio of the duration of A2 to A1 in the Brugada syndrome group was prolonged compared with that in the control group, and half of the patients with Brugada syndrome showed positive FAA, whereas only one patient in the control group showed positive FAA. The A2/A1 ratio was also prolonged in Brugada syndrome patients without AF. Open circles show Brugada syndrome patients with spontaneous AF. Solid circles show Brugada syndrome patients without spontaneous AF. The error bars represent the 95% confidence interval.