Kakishita M, Kurita T, Matsuo K, Taguchi A, Suyama K, Shimizu W, Aihara N, Kamakura S, Yamamoto F, Kobayashi J, Kosakai Y, Ohe T
Department of Cardiology, Okayama University Medical School, Japan.
J Am Coll Cardiol. 2000 Nov 1;36(5):1646-53. doi: 10.1016/s0735-1097(00)00932-3.
We sought to demonstrate the mode of spontaneous onset of ventricular fibrillation (VF) in patients with Brugada syndrome.
The electrophysiologic mechanisms of VF in Brugada syndrome have not been fully investigated.
Nineteen patients (all male, mean age 47 +/- 12 years) with Brugada syndrome were treated with an implantable cardioverter defibrillator (ICD). The implanted devices were capable of storing electrograms during an arrhythmic event. We investigated the mode of spontaneous onset of VF according to the electrocardiographic features during the episode of VF, which were obtained from stored electrograms of ICDs and/or electrocardiographic (ECG) monitoring.
During a follow-up of 34.7 +/- 19.4 months (range 14 to 81 months), 46 episodes of spontaneous VF attacks were documented in 7/19 (37%) patients. The event-free period between ICD implantation and the first spontaneous occurrence of VF was 14.6 +/- 12.1 months (range 3.7 to 27.4 months). We investigated 33/46 episodes of VF, for which electrocardiographic features (10 to 20 s before and during VF) were obtained from ICDs and/or ECG monitoring in five patients. A total of 22/33 episodes of VF were preceded by premature ventricular contractions (PVCs), which were almost identical to the initiating PVCs of VF. Furthermore, in three patients who had multiple VF episodes, VF attacks were always initiated by the same respective PVC. The coupling interval of the initiating PVCs of VF was 388 +/- 28 ms.
Spontaneous episodes of VF in patients with Brugada syndrome were triggered by specific PVCs. These findings may provide important insights into the pathophysiological mechanisms causing VF in Brugada syndrome.
我们试图阐明 Brugada 综合征患者室颤（VF）的自发发作模式。
Brugada 综合征中室颤的电生理机制尚未得到充分研究。
19 例（均为男性，平均年龄 47±12 岁）Brugada 综合征患者接受了植入式心脏复律除颤器（ICD）治疗。植入装置能够在心律失常事件期间存储心电图。我们根据室颤发作期间的心电图特征，从 ICD 的存储心电图和/或心电图（ECG）监测中获取，来研究室颤的自发发作模式。
在 34.7±19.4 个月（范围 14 至 81 个月）的随访期间，7/19（37%）患者记录到 46 次自发室颤发作。ICD 植入与首次自发发生室颤之间的无事件期为 14.6±12.1 个月（范围 3.7 至 27.4 个月）。我们研究了 46 次室颤发作中的 33 次，其中 5 例患者从 ICD 和/或 ECG 监测中获取了室颤发作前（10 至 20 秒）和发作期间的心电图特征。总共 22/33 次室颤发作之前有室性早搏（PVC），这些室性早搏与室颤的起始室性早搏几乎相同。此外，在 3 例有多次室颤发作的患者中，室颤发作总是由相同的各自室性早搏引发。室颤起始室性早搏的联律间期为 388±28 毫秒。
Brugada 综合征患者的自发室颤发作由特定的室性早搏触发。这些发现可能为 Brugada 综合征中导致室颤的病理生理机制提供重要见解。
