应用信号平均心电图对 Brugada 综合征致心律失常基质的无创评估：前瞻性临床试验的临床意义。
Non-invasive assessment of the arrhythmogenic substrate in Brugada syndrome using signal-averaged electrocardiogram: clinical implications from a prospective clinical trial.
机构信息
Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milano, Italy.
Department of Stem Cells Tissue, Stem Cells for Tissue Engineering Lab, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy.
出版信息
Europace. 2019 Dec 1;21(12):1900-1910. doi: 10.1093/europace/euz295.
AIMS
Brugada syndrome (BrS) represents a major cause of sudden cardiac death in young individuals. The risk stratification to forecast future life-threatening events is still controversial. Non-invasive assessment of late potentials (LPs) has been proposed as a risk stratification tool. However, their nature in BrS is still undetermined. The purpose of this study is to assess the electrophysiological determinants of non-invasive LPs.
METHODS AND RESULTS
Two hundred and fifty consecutive patients with (Group 1, n = 96) and without (Group 2, n = 154) BrS-related symptoms were prospectively enrolled in the registry. Signal-averaged electrocardiogram (SAECG) was performed in all subjects before undergoing epicardial mapping. Group 1 patients exhibited larger arrhythmogenic substrates (AS; 5.8 ± 2.8 vs. 2.6 ± 2.1 cm2, P < 0.001) with more delayed potentials (220.4 ± 46.0 vs. 186.7 ± 42.3 ms, P < 0.001). Late potentials were present in 82/96 (85.4%) Group 1 and in 31/154 (20.1%) Group 2 individuals (P < 0.001). Patients exhibiting LPs had more frequently a spontaneous Type 1 pattern (30.1% vs. 10.9%, P < 0.001), SCN5A mutation (34.5% vs. 21.2%, P = 0.02), and exhibited a larger AS with longer potentials (5.8 ± 2.7 vs. 2.2 ± 1.7 cm2; 231.2 ± 37.3 vs. 213.8 ± 39.0 ms; P < 0.001, respectively). Arrhythmogenic substrate dimension was the strongest predictor of the presence of LPs (odds ratio 1.9; P < 0.001). An AS area of at least 3.5 cm2 identified patients with LPs (area under the curve 0.88, 95% confidence interval 0.843-0.931; P < 0.001) with a sensitivity of 86%, specificity 88%, positive predictive value 85%, and negative predictive value 89%.
CONCLUSION
The results of this study support the role of the epicardial AS as an electrophysiological determinant of non-invasive LPs, which may serve as a tool in the non-invasive assessment of the BrS substrate, as SAECG-LPs could be considered an expression of the abnormal epicardial electrical activity.
UNLABELLED
ClinicalTrials.gov number (NCT02641431; NCT03106701).
目的
Brugada 综合征（BrS）是年轻个体心源性猝死的主要原因。预测未来危及生命事件的风险分层仍存在争议。晚电位（LPs）的非侵入性评估已被提出作为风险分层工具。然而，其在 BrS 中的性质仍未确定。本研究旨在评估非侵入性 LPs 的电生理决定因素。
方法和结果
连续 250 例有（第 1 组，n=96）和无（第 2 组，n=154）BrS 相关症状的患者前瞻性入组该研究。所有患者在接受心外膜标测前均进行信号平均心电图（SAECG）检查。第 1 组患者的致心律失常基质（AS；5.8±2.8 比 2.6±2.1 cm2，P<0.001）更大，延迟电位更多（220.4±46.0 比 186.7±42.3 ms，P<0.001）。第 1 组 82/96（85.4%）和第 2 组 31/154（20.1%）的个体存在 LPs（P<0.001）。存在 LPs 的患者更频繁地出现自发性 1 型模式（30.1%比 10.9%，P<0.001）、SCN5A 突变（34.5%比 21.2%，P=0.02），AS 更大，电位更长（5.8±2.7 比 2.2±1.7 cm2；231.2±37.3 比 213.8±39.0 ms；P<0.001）。心律失常基质的维度是存在 LPs 的最强预测因素（优势比 1.9；P<0.001）。AS 面积至少为 3.5 cm2 可识别出存在 LPs 的患者（曲线下面积 0.88，95%置信区间 0.843-0.931；P<0.001），其敏感性为 86%，特异性为 88%，阳性预测值为 85%，阴性预测值为 89%。
结论
本研究结果支持心外膜 AS 作为非侵入性 LPs 的电生理决定因素的作用，它可能作为 BrS 基质的非侵入性评估工具，因为 SAECG-LPs 可被视为异常心外膜电活动的一种表现。
临床试验注册
ClinicalTrials.gov 编号（NCT02641431；NCT03106701）。
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