Hasdemir Can, Juang Jimmy Jyh-Ming, Kose Sedat, Kocabas Umut, Orman Mehmet N, Payzin Serdar, Sahin Hatice, Celen Candan, Ozcan Emin E, Chen Ching-Yu Julius, Gunduz Ramazan, Turan Oguzhan E, Senol Oktay, Burashnikov Elena, Antzelevitch Charles
Department of Cardiology, Ege University School of Medicine, Izmir, Turkey.
Liv Hospital, Ankara, Turkey.
Pacing Clin Electrophysiol. 2018 Sep;41(9):1078-1092. doi: 10.1111/pace.13414. Epub 2018 Jul 16.
Atrial arrhythmias, particularly atrioventricular nodal reentrant tachycardia, can coexist with drug-induced type 1 Brugada electrocardiogram (ECG) pattern (DI-Type1-BrP). The present study was designed to determine the prevalence of DI-Type1-BrP in patients with atrioventricular accessory pathways (AV-APs) and to investigate the clinical, electrocardiographic, electrophysiologic, and genetic characteristics of these patients.
One-hundred twenty-four consecutive cases of AV-APs and 84 controls underwent an ajmaline challenge test to unmask DI-Type1-BrP. Genetic screening and analysis was performed in 55 of the cases (19 with and 36 without DI-Type1-BrP).
Patients with AV-APs were significantly more likely than controls to have a Type1-BrP unmasked (16.1 vs 4.8%, P = 0.012). At baseline, patients with DI-Type1-BrP had higher prevalence of chest pain, QR/rSr' pattern in V and QRS notching/slurring in V and aVL during preexcitation, rSr' pattern in V -V , and QRS notching/slurring in aVL during orthodromic atrioventricular reentrant tachycardia (AVRT) compared to patients without DI-Type1-BrP. Abnormal QRS configuration (QRS notching/slurring and/or fragmentation) in V during preexcitation was present in all patients with DI-Type1 BrP. The prevalence of spontaneous preexcited atrial fibrillation (AF) and history of AF were similar (15% vs 18.3%, P = 0.726) in patients with and without DI-Type1-BrP, respectively. The prevalence of mutations in Brugada-susceptibility genes was higher (36.8% vs 8.3%, P = 0.02) in patients with DI-Type1-BrP compared to patients without DI-Type1-BrP.
DI-Type1-BrP is relatively common in patients with AV-APs. We identify 12-lead ECG characteristics during preexcitation and orthodromic AVRT that point to an underlying type1-BrP, portending an increased probability for development of malignant arrhythmias.
房性心律失常，尤其是房室结折返性心动过速，可与药物诱导的1型Brugada心电图（ECG）模式（DI-Type1-BrP）共存。本研究旨在确定房室旁道（AV-APs）患者中DI-Type1-BrP的患病率，并研究这些患者的临床、心电图、电生理和遗传特征。
124例连续的AV-APs患者和84例对照者接受了阿义马林激发试验以揭示DI-Type1-BrP。对55例患者（19例有DI-Type1-BrP，36例无DI-Type1-BrP）进行了基因筛查和分析。
AV-APs患者比对照者更有可能揭示出1型BrP（16.1%对4.8%，P = 0.012）。在基线时，与无DI-Type1-BrP的患者相比，有DI-Type1-BrP的患者胸痛患病率更高，预激时V导联出现QR/rSr'模式以及V导联和aVL导联QRS切迹/顿挫，V1-V3导联出现rSr'模式，以及顺向型房室折返性心动过速（AVRT）时aVL导联出现QRS切迹/顿挫。所有有DI-Type1 BrP的患者在预激时V导联均出现异常QRS形态（QRS切迹/顿挫和/或碎裂）。有和无DI-Type1-BrP的患者中，自发预激性心房颤动（AF）的患病率和AF病史相似（分别为15%对18.3%，P = 0.726）。与无DI-Type1-BrP的患者相比，有DI-Type1-BrP的患者中Brugada易感性基因突变的患病率更高（36.8%对8.3%，P = 0.02）。
DI-Type1-BrP在AV-APs患者中相对常见。我们识别出预激和顺向型AVRT期间的12导联心电图特征，这些特征提示潜在的1型BrP，预示发生恶性心律失常的可能性增加。
