Paul Matthias, Gerss Joachim, Schulze-Bahr Eric, Wichter Thomas, Vahlhaus Christian, Wilde Arthur A M, Breithardt Günter, Eckardt Lars
Department of Cardiology and Angiology, University Hospital of Muenster, Albert-Schweitzer-Str. 33, D-48149 Muenster, Germany.
Eur Heart J. 2007 Sep;28(17):2126-33. doi: 10.1093/eurheartj/ehm116. Epub 2007 May 5.
Brugada syndrome (BS) is an ion channelopathy with the risk of sudden cardiac death. The role of programmed ventricular stimulation (PVS) in risk stratification has been controversially discussed. Therefore, we performed a meta-analysis on the prognostic role of PVS in BS.
A Medline search until July 2006 documented 822 entries for BS. Only English publications with > 10 patients and a follow-up period were considered (n = 15). Patients [n = 1217; 974 males (80%)] were divided into three groups: survived sudden cardiac arrest (SCA) [n = 222 (18%)], syncope (Syncope) [n = 275 (23%)], and asymptomatic patients (Asympt) [n = 720 (59%)]. PVS was conducted in 1036 patients (85%). In 548 patients (53%), sustained ventricular tachyarrhythmias (VT) or ventricular fibrillation (VF) was inducible. During follow-up (34 +/- 40 months), VT/VF occurred in 141 patients. SCA bore the highest chance for a VT/VF occurrence during follow-up [odds ratio (OR) 14.4 compared with asymptomatic patients; P < 0.0005]. However, except for one study, the OR for VT/VF during follow-up in relation to VT/VF inducibility was non-significant (OR 1.5; P = ns).
The main finding is that we were unable to identify a significant role of PVS with regard to arrhythmic events during follow-up in BS, thus questioning the role of PVS for risk stratification in patients with BS. Patients with BS and survived SCA show the highest chance for VT/VF occurrence during follow-up.
Brugada综合征（BS）是一种具有心脏性猝死风险的离子通道病。程控心室刺激（PVS）在风险分层中的作用一直存在争议。因此，我们对PVS在BS中的预后作用进行了一项荟萃分析。
截至2006年7月的Medline检索记录了822条关于BS的条目。仅纳入患者数>10例且有随访期的英文出版物（n = 15）。患者[n = 1217；974例男性（80%）]分为三组：心脏骤停幸存者（SCA）[n = 222（18%）]、晕厥患者（Syncope）[n = 275（23%）]和无症状患者（Asympt）[n = 720（59%）]。1036例患者（85%）接受了PVS。548例患者（53%）可诱发出持续性室性快速心律失常（VT）或心室颤动（VF）。在随访期间（34±40个月），141例患者发生了VT/VF。SCA在随访期间发生VT/VF的可能性最高[与无症状患者相比，优势比（OR）为14.4；P < 0.0005]。然而，除一项研究外，随访期间VT/VF发生与VT/VF可诱发性的OR无统计学意义（OR 1.5；P = 无统计学意义）。
主要发现是，我们无法确定PVS在BS患者随访期间心律失常事件方面的显著作用，因此对PVS在BS患者风险分层中的作用提出质疑。BS且心脏骤停存活的患者在随访期间发生VT/VF的可能性最高。
