Heart Rhythm Management Center, Vrije Universiteit Brussel, Belgium, UK.
J Cardiovasc Electrophysiol. 2012 Mar;23(3):290-5. doi: 10.1111/j.1540-8167.2011.02193.x. Epub 2011 Oct 10.
The Brugada syndrome (BrS) can first present with syncope. Class-I antiarrhythmic drug (AAD) test is used to unmask the diagnostic coved-type ECG pattern in case it is not spontaneously present. The aim of the study was to analyze patients with BrS presenting with syncope as first manifestation and compare patients with syncope and a spontaneous coved-type ECG to patients with syncope in whom a class-I AAD test unmasked the disease.
Fifty-eight of 157 probands (36.9%) had syncope as first manifestation of the disease. Twenty-six patients (44.8%, group A) showed a spontaneous coved-type ECG diagnostic for BrS at first presentation. In 32 patients (55.2%, group B) without spontaneous coved-type ECG pattern at first presentation (36% normal ECGs and 19% type-II ECG pattern), a class-I AAD test unmasked the disease. Twenty-one patients of group A and 29 patients of group B underwent implantable cardioverter defibrillator (ICD) implantation. The mean follow up as 9.7 ± 55.7 month. Four patients in group A (15.4%) and 3 patients (9.3%) in group B had appropriate ICD shock delivery due to ventricular fibrillation or ventricular tachycardia (P = NS).
One of 3 patients with BrS presents first with syncope. More than one-third of these patients have a normal ECG at investigation for syncope and the correct diagnosis would have been missed without a class-I AAD test. Patients presenting with syncope are at similar risk irrespective of the presence of a spontaneous coved-type ECG.
Brugada 综合征（BrS）可首先表现为晕厥。在自发性 coved 型心电图（ECG）模式不出现时，使用 I 类抗心律失常药物（AAD）试验来揭示诊断性 coved 型 ECG 模式。本研究的目的是分析以晕厥为首发表现的 BrS 患者，并比较首次出现晕厥且具有自发性 coved 型 ECG 的患者与因 I 类 AAD 试验而揭示疾病的晕厥患者。
157 名先证者中有 58 例（36.9%）以晕厥为首发症状。26 例（44.8%，A 组）首次就诊时出现自发性 coved 型 ECG，诊断为 BrS。在首次就诊时无自发性 coved 型 ECG 模式的 32 例患者（55.2%，B 组）中（36%正常 ECG 和 19% II 型 ECG 模式），I 类 AAD 试验揭示了该疾病。A 组的 21 例和 B 组的 29 例患者接受了植入式心脏复律除颤器（ICD）植入。平均随访时间为 9.7±55.7 个月。A 组中有 4 例（15.4%）和 B 组中有 3 例（9.3%）患者因室颤或室性心动过速而发生适当的 ICD 电击治疗（P=NS）。
1/3 的 BrS 患者首发症状为晕厥。在晕厥检查中，这些患者中有超过三分之一的心电图正常，如果没有 I 类 AAD 试验，就会错过正确的诊断。出现晕厥的患者的风险相似，而与是否存在自发性 coved 型 ECG 无关。
