Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center, Suita, Japan.
J Cardiovasc Electrophysiol. 2010 Feb;21(2):186-92. doi: 10.1111/j.1540-8167.2009.01599.x. Epub 2009 Sep 28.
Patients with type 1 Brugada electrocardiogram (ECG) and an episode of syncope are diagnosed as symptomatic Brugada syndrome; however, all episodes of syncope may not be due to ventricular tachyarrhythmia.
Forty-six patients with type 1 Brugada ECG (all males, 51 +/- 13 years, 29 spontaneous, 17 Ic-drug induced), 20 healthy control subjects (all males, 35 +/- 11 years), and 15 patients with suspected neurally mediated syncope (NMS; 9 males, 54 +/- 22 years) underwent the head-up tilt (HUT) test. During the HUT test, 12-lead ECGs were recorded in all patients, and the heart rate variability was investigated in some patients. Sixteen (35%) of 46 patients with Brugada ECG, 2 (10%) of 20 control subjects, and 10 (67%) of 15 patients with suspected NMS showed positive responses to the HUT test. Although no significant differences were observed in HUT-positive rate among Brugada patients with documented VT (7/14; 50%), syncope (5/19; 26%) and asymptomatic patients (4/13; 31%), the HUT-positive rate was significantly higher in patients with documented VT (50%) and those with VT or no symptoms (11/27, 41%) compared to that in control subjects (10%) (P < 0.05). Augmentation of ST-segment amplitude (> or =0.05 mV) in leads V1-V3 was observed in 11 (69%) of 16 HUT-positive patients with Brugada ECG during vasovagal responses, and was associated with augmentation of parasympathetic tone following sympathetic withdrawal.
Thirty-five percent of patients with Brugada ECG showed vasovagal responses during the HUT test, suggesting that some Brugada patients have impaired balance of autonomic nervous system, which may relate to their syncopal episodes.
患有 1 型 Brugada 心电图（ECG）并伴有晕厥发作的患者被诊断为有症状的 Brugada 综合征；然而，并非所有晕厥发作均由室性心动过速/颤动引起。
46 例 1 型 Brugada 心电图患者（均为男性，年龄 51±13 岁，29 例自发，17 例 Ic 类药物诱导），20 例健康对照者（均为男性，年龄 35±11 岁）和 15 例疑似神经介导性晕厥（NMS；9 例男性，年龄 54±22 岁）接受了直立倾斜试验（HUT）。在 HUT 试验中，所有患者均记录 12 导联心电图，并对部分患者进行了心率变异性研究。在 Brugada 心电图患者中，16 例（35%）、20 例对照者中 2 例（10%）和 15 例疑似 NMS 患者中有 10 例（67%）对 HUT 试验呈阳性反应。虽然在有记录的 VT（7/14；50%）、晕厥（5/19；26%）和无症状患者（4/13；31%）中 Brugada 患者的 HUT 阳性率之间没有显著差异，但在有记录的 VT 患者（50%）和有 VT 或无症状患者（11/27，41%）中，HUT 阳性率显著高于对照者（10%）（P<0.05）。在 16 例 Brugada 心电图 HUT 阳性患者中，有 11 例（69%）在血管迷走反应期间观察到 V1-V3 导联 ST 段振幅增加（>0.05 mV），并且与交感神经抑制后副交感神经张力增加有关。
35%的 Brugada 心电图患者在 HUT 试验中出现血管迷走反应，这表明一些 Brugada 患者自主神经系统平衡受损，这可能与他们晕厥发作有关。
