临床评估和电生理研究在晕厥的 Brugada 综合征患者中的作用。

The role of clinical assessment and electrophysiology study in Brugada syndrome patients with syncope.

机构信息

Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona. Barcelona, Spain; IDIBAPS, Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain.

Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona. Barcelona, Spain; IDIBAPS, Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.

出版信息

Am Heart J. 2020 Feb;220:213-223. doi: 10.1016/j.ahj.2019.10.016. Epub 2019 Nov 8.

DOI:10.1016/j.ahj.2019.10.016

PMID:31864099

Abstract

BACKGROUND

Cardiogenic syncope in Brugada syndrome (BrS) increases the risk of major events. Nevertheless, clinical differentiation between cardiogenic and vasovagal syncope can be challenging. We characterized the long-term incidence of major events in a large cohort of BrS patients who presented with syncope.

METHODS

From a total of 474 patients, syncope was the initial manifestation in 135 (28.5%) individuals (43.9 ± 13.9 years, 71.1% male). The syncope was classified prospectively as cardiogenic, vasovagal, or undefined if unclear characteristics were present. Clinical, electrocardiographic, genetic, and electrophysiologic features were analyzed. Cardiogenic syncope, sustained ventricular arrhythmias, and sudden death were considered major events in follow-up.

RESULTS

In 66 patients (48.9%), the syncope was cardiogenic; in 51 (37.8%), vasovagal and in 18 (13.3%); undefined. The electrophysiology study (EPS) inducibility was more frequent in patients with cardiogenic syncope and absent in all patients with undefined syncope (28 [53.8%] vs 5 [12.2%] vs 0 [0%]; P < .01). During follow-up (7.7 ± 5.6 years), only patients with cardiogenic syncope presented major events (16 [11.9%]). Among patients with inducible EPS, 7 (21.2%) presented major events (P = .04). The negative predictive value of the EPS for major events was 92.4%. The incidence rate of major events was 2.6% person-year. Parameters associated with major events included cardiogenic syncope (hazard ratio [HR] 6.3; 95% CI 1.1-10.4; P = .05), spontaneous type 1 electrocardiogram (HR 3.7; 95% CI 1.3-10.5; P = .01), and inducible EPS (HR 2.8; 95% CI 1.1-8.8; P = .05).

CONCLUSIONS

An accurate syncope classification is crucial in BrS patients for risk stratification. In patients with syncope of unclear characteristics, the EPS may be helpful to prevent unnecessary implantable cardioverter defibrillators.

摘要

背景

Brugada 综合征（BrS）引起的心源性晕厥会增加发生重大事件的风险。然而，心源性晕厥与血管迷走性晕厥之间的临床鉴别可能具有挑战性。我们对一组晕厥首发的 BrS 患者进行了长期重大事件发生率的特征描述。

方法

共纳入 474 例患者，其中 135 例（28.5%）患者以晕厥为首发表现（43.9±13.9 岁，71.1%为男性）。晕厥前瞻性分类为心源性、血管迷走性或不明原因（如果特征不明确）。分析临床、心电图、遗传学和电生理特征。心源性晕厥、持续性室性心律失常和猝死被认为是随访中的重大事件。

结果

66 例（48.9%）患者晕厥为心源性，51 例（37.8%）为血管迷走性，18 例（13.3%）为不明原因。电生理研究（EPS）可诱导性在心源性晕厥患者中更为常见，而在所有不明原因晕厥患者中均未出现（28[53.8%]例 vs 5[12.2%]例 vs 0[0%]例；P<.01）。在随访（7.7±5.6 年）期间，只有心源性晕厥患者发生重大事件（16[11.9%]例）。在可诱导 EPS 的患者中，有 7 例（21.2%）发生重大事件（P=.04）。EPS 对重大事件的阴性预测值为 92.4%。重大事件的发生率为 2.6%人年。与重大事件相关的参数包括心源性晕厥（危险比 [HR]6.3；95%置信区间 1.1-10.4；P=.05）、自发性 1 型心电图（HR 3.7；95%置信区间 1.3-10.5；P=.01）和可诱导 EPS（HR 2.8；95%置信区间 1.1-8.8；P=.05）。