既往无心脏骤停的Brugada综合征患者的危险分层——联合危险因素的预后价值

Risk stratification in patients with Brugada syndrome without previous cardiac arrest – prognostic value of combined risk factors.

作者信息

Okamura Hideo, Kamakura Tsukasa, Morita Hiroshi, Tokioka Koji, Nakajima Ikutaro, Wada Mitsuru, Ishibashi Kohei, Miyamoto Koji, Noda Takashi, Aiba Takeshi, Nishii Nobuhiro, Nagase Satoshi, Shimizu Wataru, Yasuda Satoshi, Ogawa Hisao, Kamakura Shiro, Ito Hiroshi, Ohe Tohru, Kusano Kengo F

机构信息

Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan..

出版信息

Circ J. 2015;79(2):310-7. doi: 10.1253/circj.CJ-14-1059. Epub 2014 Nov 26.

DOI:10.1253/circj.CJ-14-1059

PMID:25428522

Abstract

BACKGROUND

Risk stratification in patients with Brugada syndrome for primary prevention of sudden cardiac death is still an unsettled issue. A recent consensus statement suggested the indication of implantable cardioverter defibrillator (ICD) depending on the clinical risk factors present (spontaneous type 1 Brugada electrocardiogram (ECG) [Sp1], history of syncope [syncope], and ventricular fibrillation during programmed electrical stimulation [PES+]). The indication of ICD for the majority of patients, however, remains unclear.

METHODS AND RESULTS

A total of 218 consecutive patients (211 male; aged 46 ± 13 years) with a type 1 Brugada ECG without a history of cardiac arrest who underwent evaluation for ICD including electrophysiological testing were examined retrospectively. During a mean follow-up period of 78 months, 26 patients (12%) developed arrhythmic events. On Kaplan-Meier analysis patients with each of Sp1, syncope, or PES+ suffered arrhythmic events more frequently (P=0.018, P<0.001, and P=0.003, respectively). On multivariate analysis Sp1 and syncope were independent predictors of arrhythmic events. When dividing patients according to the number of these 3 risk factors present, patients with 2 or 3 risk factors experienced arrhythmic events more frequently than those with 0 or 1 risk factor (23/93 vs. 3/125; P<0.001).

CONCLUSIONS

Syncope, Sp1, and PES+ are important risk factors and the combination of these risks well stratify the risk of later arrhythmic events.

摘要

背景

对于 Brugada 综合征患者进行心脏性猝死一级预防的风险分层仍是一个未解决的问题。最近的一项共识声明建议根据存在的临床风险因素（自发性 1 型 Brugada 心电图 [Sp1]、晕厥病史 [晕厥] 和程序电刺激期间的室颤 [PES+]）来决定植入式心律转复除颤器（ICD）的适应证。然而，大多数患者 ICD 的适应证仍不明确。

方法和结果

回顾性分析了 218 例连续的无心脏骤停病史且心电图为 1 型 Brugada 的患者（211 例男性；年龄 46±13 岁），这些患者接受了包括电生理检查在内的 ICD 评估。在平均 78 个月的随访期间，26 例患者（12%）发生了心律失常事件。在 Kaplan-Meier 分析中，Sp1、晕厥或 PES+ 患者发生心律失常事件的频率更高（分别为 P = 0.018、P < 0.001 和 P = 0.003）。多因素分析显示 Sp1 和晕厥是心律失常事件的独立预测因素。根据存在的这 3 个风险因素的数量对患者进行分组时，有 2 个或 3 个风险因素的患者比有 0 个或 1 个风险因素的患者发生心律失常事件的频率更高（23/93 对 3/125；P < 0.001）。