Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
Heart Rhythm. 2018 Oct;15(10):1468-1474. doi: 10.1016/j.hrthm.2018.06.035. Epub 2018 Jun 25.
Various risk stratifications in asymptomatic patients with Brugada syndrome (BrS) have been proposed, but the electrophysiological change that promotes ventricular fibrillation (VF) is still unknown.
The aim of this study was to clarify the changes in electrocardiographic (ECG) markers at the onset of VF from ECGs recorded when patients were still asymptomatic.
The subjects of this study included 14 patients with VF and 48 consecutive asymptomatic patients with BrS. We compared ECGs before the initial VF events (>6 months; early phase) with ECGs at the initial VF events (late phase). In asymptomatic patients, we evaluated ECGs at 2 time points with an interval of >6 months. We evaluated various ECG markers including type 1 ECG and fragmented QRS (fQRS; multiple spikes within the QRS complex).
ECG parameters of the early and late phases were not different except for decreased ST voltage and low incidence of type 1 ECG in asymptomatic patients. There were no differences in ECG parameters of the early phase between patients with VF and asymptomatic patients. In patients with VF, ECGs at the late phase had longer QRS intervals and intervals between the peak and the end of the T wave and more frequent type 1 ECG and fQRS than did ECGs at the early phase. Those changes were associated with initial VF events (QRS widening: odds ratio [OR] 11.5, P < .01; interval between the peak and the end of the T wave: OR 11.6, P < .01; fQRS: odds ratio 15.3, P < .01; type 1 ECG: OR 6.6, P < .05).
QRS and ST-T wave abnormalities developed in association with the initial VF events. Aggravation of the conduction disturbance in addition to BrS-ECG promotes VF.
已提出各种无症状 Brugada 综合征（BrS）患者的风险分层，但促进室颤（VF）的电生理变化仍不清楚。
本研究旨在阐明从患者仍无症状时记录的心电图（ECG）中VF 发作时 ECG 标记物的变化。
本研究的对象包括 14 例 VF 患者和 48 例连续无症状 BrS 患者。我们比较了首次 VF 事件前（>6 个月；早期）与首次 VF 事件时（晚期）的 ECG。在无症状患者中，我们评估了间隔>6 个月的 2 个时间点的 ECG。我们评估了各种 ECG 标记物，包括 1 型 ECG 和碎裂 QRS（fQRS；QRS 复合波内的多个尖峰）。
除无症状患者的 ST 电压降低和 1 型 ECG 发生率低外，早期和晚期 ECG 参数无差异。VF 患者与无症状患者的早期阶段 ECG 参数无差异。在 VF 患者中，晚期 ECG 的 QRS 间隔较长，T 波峰值与终点之间的间隔较长，1 型 ECG 和 fQRS 更频繁，而早期 ECG 则不然。这些变化与初始 VF 事件相关（QRS 增宽：优势比[OR]11.5，P<.01；T 波峰值与终点之间的间隔：OR 11.6，P<.01；fQRS：OR 15.3，P<.01；1 型 ECG：OR 6.6，P<.05）。
除 BrS-ECG 外，QRS 和 ST-T 波异常与初始 VF 事件相关。传导障碍的加重除了 BrS-ECG 外还会促进 VF。
