Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Heart Rhythm. 2012 Feb;9(2):242-8. doi: 10.1016/j.hrthm.2011.09.053. Epub 2011 Sep 20.
Use of programmed electrical stimulation (PES) for risk stratification of Brugada syndrome (BrS) is controversial.
To elucidate the role of the number of extrastimuli during PES in patients with BrS.
Consecutive 108 patients with type 1 electrocardiogram (104 men, mean age 46 ± 12 years; 26 with ventricular fibrillation [VF], 40 with syncope, and 42 asymptomatic) underwent PES with a maximum of 3 extrastimuli from the right ventricular apex and the right ventricular outflow tract. Ventricular arrhythmia (VA) was defined as VF or nonsustained polymorphic ventricular tachycardia >15 beats. Patients with VA induced by a single extrastimulus or double extrastimuli were assigned to group SD (Single/Double), by triple extrastimuli to group T (Triple), and the remaining patients to group N.
VA was induced in 81 patients (VF in 71 and polymorphic ventricular tachycardia in 10), in 4 by a single extrastimulus, in 41 by double extrastimuli, and in 36 by triple extrastimuli. During 79 ± 48 months of follow-up, 24 patients had VF events. Although the overall inducibility of VA was not associated with an increased risk of VF (log-rank P = .78), group SD had worse prognosis than did group T (P = .004). Kaplan-Meier analysis in patients without prior VF also showed that group SD had poorer outcome than did group T and group N (P = .001). Positive and negative predictive values of VA induction with up to 2 extrastimuli were, respectively, 36% and 87%, better than those with up to 3 (23% and 81%, respectively).
The number of extrastimuli that induced VA served as a prognostic indicator for patients with Brugada type 1 electrocardiogram. Single extrastimulus or double extrastimuli were adequate for PES of patients with BrS.
程序性电刺激（PES）在 Brugada 综合征（BrS）风险分层中的应用存在争议。
阐明 PES 时额外刺激的数量在 BrS 患者中的作用。
连续 108 例 1 型心电图（104 例男性，平均年龄 46±12 岁；26 例心室颤动[VF]，40 例晕厥，42 例无症状）接受右心室心尖和右心室流出道最多 3 个额外刺激的 PES。室性心律失常（VA）定义为 VF 或非持续多形性室性心动过速>15 次。仅通过单个额外刺激或双个额外刺激诱发 VA 的患者被分配到 SD 组（单/双），通过 3 个额外刺激则分到 T 组（三），其余患者分到 N 组。
81 例患者（VF71 例，多形性室性心动过速 10 例）诱发 VA，4 例通过单个额外刺激，41 例通过双个额外刺激，36 例通过 3 个额外刺激。在 79±48 个月的随访期间，24 例患者发生 VF 事件。尽管 VA 的整体诱发性与 VF 风险增加无关（对数秩 P=.78），但 SD 组的预后比 T 组差（P=.004）。在没有既往 VF 的患者中进行的 Kaplan-Meier 分析也表明，SD 组的预后比 T 组和 N 组差（P=.001）。多达 2 个额外刺激诱发 VA 的阳性和阴性预测值分别为 36%和 87%，优于多达 3 个额外刺激的（23%和 81%）。
诱发 VA 的额外刺激数量可作为 Brugada 1 型心电图患者的预后指标。对于 BrS 患者，单个额外刺激或双个额外刺激足以进行 PES。
