Ozeke Ozcan, Cağli Kumral Ergün, Aras Dursun, Ilkay Erdoğan
Department of Cardiology, MESA Hospital, Ankara, Turkey.
Turk Kardiyol Dern Ars. 2009 Mar;37(2):128-31.
It is well-known that autonomic nerve modulation has an important role in the occurrence of ventricular tachyarrhythmias in Brugada syndrome. A 59-year-old man underwent cardiac evaluation before surgery for urinary bladder stone. He had no cardiac complaints and the only coronary risk factor was heavy smoking. The electrocardiogram showed a saddleback type ST-segment elevation in leads V1-V2, and left axis deviation. During exercise stress test, ventricular tachycardia with a left bundle branch block pattern appeared, and the saddleback type ST-segment elevation in V2 changed into a coved-type ECG at the recovery phase. The ventricular tachycardia was hemodynamically stable and normalized without medication. An echocardiogram showed normal left and right ventricular functions, and subsequent coronary angiography revealed normal coronary arteries. Based on these findings, a diagnosis of asymptomatic Brugada syndrome was made. Considering this particular case, it can be speculated that bladder-cardiac reflex may stimulate the autonomic nervous system via the vagus nerve and unmask Brugada syndrome.
众所周知，自主神经调节在Brugada综合征室性快速性心律失常的发生中起重要作用。一名59岁男性在接受膀胱结石手术前接受了心脏评估。他没有心脏方面的主诉，唯一的冠状动脉危险因素是大量吸烟。心电图显示V1-V2导联呈鞍背型ST段抬高，电轴左偏。运动负荷试验期间，出现了左束支传导阻滞型室性心动过速，V2导联的鞍背型ST段抬高在恢复期转变为穹窿型心电图。室性心动过速血流动力学稳定，未用药自行恢复正常。超声心动图显示左、右心室功能正常，随后的冠状动脉造影显示冠状动脉正常。基于这些发现，诊断为无症状Brugada综合征。考虑到这个特殊病例，可以推测膀胱-心脏反射可能通过迷走神经刺激自主神经系统，从而使Brugada综合征显现出来。
