Hermida Jean-Sylvain, Denjoy Isabelle, Jarry Geneviève, Jandaud Serge, Bertrand Cathy, Delonca Jean
Amiens-Picardie University Hospital, Hôpital Sud, France.
Europace. 2005 Sep;7(5):447-53. doi: 10.1016/j.eupc.2005.05.005.
To identify ECG predictors of Brugada type response during Na channel blockade challenge.
We studied prospectively 103 patients (M = 76, 45 +/- 13 years) in whom ECGs were collected during ajmaline challenge. ECG recordings included the high right precordial leads (-2V(1) and -2V(2)). A positive response was defined by a >0.2 mV J point or ST segment elevation and a down-sloping pattern of the ST segment in at least one right precordial lead.
Ajmaline challenge was positive in 48 (47%) of the 103 cases. Baseline J wave elevation was greater in -2V(1) (0.077 +/- 0.078 mV vs. 0.038 +/- 0.046 mV, P = 0.003) and -2V(2) (0.149 +/- 0.103 mV vs. 0.043 +/- 0.088 mV, P < 0.001) in cases with a subsequent positive response. In contrast, ST segment elevation and T wave amplitudes were reduced in V(1), V(2) and V(3). Logistic regression showed that J wave elevation in -2V(2) and decreased T wave amplitude in V(3) at baseline were independent predictors of a positive response. Baseline J wave elevation >0.16 mV in -2V(2) had a specificity of 100%, a sensitivity of 40%, a positive predictive value of 100% and a negative predictive value of 28%.
J wave elevation >0.16 mV in -2V(2) was the strongest predictor of a Brugada type response to Na channel blockade challenge when Brugada syndrome was suspected on a baseline ECG.
确定钠通道阻滞剂激发试验期间Brugada型反应的心电图预测指标。
我们前瞻性地研究了103例患者（男性76例，年龄45±13岁），在阿义马林激发试验期间收集其心电图。心电图记录包括高位右胸导联（-2V1和-2V2）。阳性反应定义为至少一个右胸导联的J点或ST段抬高>0.2 mV以及ST段呈下斜型。
103例患者中48例（47%）阿义马林激发试验呈阳性。后续呈阳性反应的病例中，基线J波抬高在-2V1（0.077±0.078 mV对0.038±0.046 mV，P = 0.003）和-2V2（0.149±0.103 mV对0.043±0.088 mV，P<0.001）导联中更高。相比之下，V1、V2和V3导联的ST段抬高和T波振幅降低。逻辑回归显示，基线时-2V2导联的J波抬高和V3导联的T波振幅降低是阳性反应的独立预测指标。基线时-2V2导联J波抬高>0.16 mV的特异性为100%，敏感性为40%，阳性预测值为100%，阴性预测值为28%。
当基线心电图怀疑有Brugada综合征时，-2V2导联J波抬高>0.16 mV是对钠通道阻滞剂激发试验呈Brugada型反应的最强预测指标。
