Babai Bigi Mohamad Ali, Aslani Amir, Shahrzad Shahab
Cardiology Department, Shiraz University of Medical Sciences, Shiraz, Iran.
Heart Rhythm. 2007 Aug;4(8):1009-12. doi: 10.1016/j.hrthm.2007.04.017. Epub 2007 May 4.
Risk stratification in Brugada syndrome (BS) is controversial, especially in asymptomatic individuals.
The aim of this study was to evaluate the significance of lead aVR in patients with BS.
Twenty-four patients with the electrocardiogram pattern of BS (24 male, mean age 32.1 +/- 13.6 years) and 24 healthy age- and gender-matched controls were studied.
Thirteen patients were symptomatic. The R-wave amplitude or R/q ratio in lead aVR was significantly greater in patients experiencing a recurrence compared with those who did not. The aVR sign was defined as R wave >/= 0.3 mV or R/q >/= 0.75 in lead aVR. Most of the recurrences (78%) were in patients with present aVR sign; 84% of BS patients with present aVR sign had events during follow-up. In contrast, only 27% of BS patients with absent aVR sign had events during follow-up.
Our study shows significant correlation between a prominent R wave in lead aVR (aVR sign) and risk for development of arrhythmic events in BS. In the presence of BS, prominent R wave in lead aVR may reflect more right ventricular conduction delay and subsequently more electrical heterogeneity, which in turn is responsible for a higher risk of arrhythmia.
Brugada综合征（BS）的风险分层存在争议，尤其是在无症状个体中。
本研究旨在评估aVR导联在BS患者中的意义。
对24例具有BS心电图特征的患者（24例男性，平均年龄32.1±13.6岁）和24例年龄及性别匹配的健康对照者进行研究。
13例患者有症状。与未复发的患者相比，复发患者aVR导联的R波振幅或R/q比值显著更高。aVR征定义为aVR导联R波≥0.3 mV或R/q≥0.75。大多数复发（78%）发生在有aVR征的患者中；有aVR征的BS患者中84%在随访期间发生事件。相比之下，无aVR征的BS患者在随访期间只有27%发生事件。
我们的研究表明，aVR导联突出的R波（aVR征）与BS患者发生心律失常事件的风险之间存在显著相关性。在存在BS的情况下，aVR导联突出的R波可能反映更多的右心室传导延迟，进而反映更多的电不均一性，这反过来又导致更高的心律失常风险。
