Leong Kevin M W, Ng Fu Siong, Jones Sian, Chow Ji-Jian, Qureshi Norman, Koa-Wing Michael, Linton Nicholas W F, Whinnett Zachary I, Lefroy David C, Davies David Wyn, Lim Phang Boon, Peters Nicholas S, Kanagaratnam Prapa, Varnava Amanda M
National Heart and Lung Institute, Imperial College London, London, UK.
Imperial College Healthcare NHS Trust, London, UK.
Pacing Clin Electrophysiol. 2019 Feb;42(2):257-264. doi: 10.1111/pace.13587. Epub 2019 Jan 6.
A spontaneous type I electrocardiogram (ECG) pattern and/or unheralded syncope are conventionally used as risk markers for primary prevention of sudden cardiac arrest/death (SCA/SCD) in Brugada syndrome (BrS). In this study, we determine the prevalence of conventional and newer markers of risk in those with and without previous aborted SCA events.
All patients with BrS were identified at our institute. History of symptoms was obtained from medical tests or from interviews. Other markers of risk were also obtained, such as presence of (1) spontaneous type I pattern, (2) fractionated QRS (fQRS), (3) early repolarization (ER) pattern, (4) late potentials on signal-averaged ECG (SAECG), and (5) response to programmed electrical stimulation.
In 133 patients with Bars, 10 (7%) patients (mean age = 39 ± 11 years; nine males) were identified with a previous ventricular fibrillation/ventricular tachycardia episode (n = 8) or requiring cardio-pulmonary resuscitation (n = 2). None of these patients had a prior history of syncope before their SCA event. Only two (20%) patients reported a history of palpitations or dizziness. None had apneic breathing and three (30%) patients had a family history of SCA. From their ECGs, a spontaneous pattern was only found in one (10%) of these patients. Further, 10% of patients had fQRS, 17% had late potentials on SAECG, 20% had deep S waves in lead I, and 10% had an ER pattern in the peripheral leads. No significant differences were observed in the non-SCA group.
The majority of BrS patients with previous aborted SCA events did not have a spontaneous type I and/or prior history of syncope. Conventional and newer markers of risk appear to only have limited ability to predict SCA.
自发性I型心电图（ECG）模式和/或不明原因的晕厥通常被用作Brugada综合征（BrS）心脏骤停/猝死（SCA/SCD）一级预防的风险标志物。在本研究中，我们确定了有或无前驱性SCA事件患者中传统和新型风险标志物的患病率。
在我们研究所识别出所有BrS患者。通过医学检查或访谈获取症状史。还获取了其他风险标志物，如（1）自发性I型模式、（2）碎裂QRS波（fQRS）、（3）早期复极（ER）模式、（4）信号平均心电图（SAECG）上的晚电位，以及（5）对程序电刺激的反应。
在133例BrS患者中，10例（7%）患者（平均年龄 = 39 ± 11岁；9例男性）被确定有先前的室颤/室性心动过速发作（n = 8）或需要心肺复苏（n = 2）。这些患者在SCA事件发生前均无晕厥病史。只有2例（20%）患者报告有心悸或头晕病史。无人有呼吸暂停，3例（30%）患者有SCA家族史。从他们的心电图来看，这些患者中只有1例（10%）发现有自发性模式。此外，10%的患者有fQRS，17%的患者SAECG上有晚电位，20%的患者I导联有深S波，10%的患者外周导联有ER模式。非SCA组未观察到显著差异。
大多数有前驱性SCA事件的BrS患者没有自发性I型和/或晕厥病史。传统和新型风险标志物似乎仅具有有限的预测SCA的能力。
