Heart Rhythm Management Center, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium; European Reference Networks Guard-Heart, Brussels, Belgium.
Centre for Medical Genetics Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium; European Reference Networks Guard-Heart, Brussels, Belgium.
Am J Cardiol. 2020 Nov 15;135:91-98. doi: 10.1016/j.amjcard.2020.08.024. Epub 2020 Aug 27.
Brugada syndrome (BrS) diagnosis requires the presence of a typical type 1 ECG pattern. Owing to the spontaneous ECG variability, the real BrS prevalence in the general population remains unclear. The aim of the present study was to evaluate the prevalence of positive ajmaline challenge for BrS in a cohort of consecutive patients who underwent electrophysiological evaluation for different clinical reasons. All consecutive patients from 2008 to 2019 who underwent ajmaline testing were prospectively included. A total of 2,456 patients underwent ajmaline testing, 742 (30.2%) in the context of familial screening for BrS. In non-familial screening group (1,714) ajmaline testing resulted positive in 186 (10.9%). Indications for ajmaline testing were: suspicious BrS ECG in 23 cases (12.4%), palpitations in 27 (14.5%), syncope in 71 (38.2%), presyncope in 7 (3.8%), family history of sudden cardiac death in 18 (9.7%), documented ventricular arrhythmias in 12 (6.5%), unexplained cardiac arrest in 4 (2.2%), atrial fibrillation in 16 (8.5%), brady-arrhythmias in 1 (0.5%), and cerebrovascular accidents in 7 (3.7%). Compared with the overall population, ajmaline testing positive patients were younger (42.8 ± 15.5 vs 48.9 ± 20.4; p <0.001) and more frequently male (65.1% vs 56.3%; p = 0.023). Implantable cardioverter defibrillator was implanted in 84 patients (45.2%). During a median follow-up of 42.4 months, 12 appropriate shocks and 13 implantable cardioverter defibrillator related complications were reported. In conclusion, the BrS was diagnosed in an unexpected high proportion of patients that underwent ajmaline testing for a variety of cardiovascular symptoms. This can lead to an adequate counseling and clinical management in BrS patients.
布鲁加达综合征 (BrS) 的诊断需要存在典型的 1 型心电图模式。由于心电图的自发性变化，普通人群中真正的 BrS 患病率仍不清楚。本研究的目的是评估在因不同临床原因接受电生理评估的连续患者队列中，进行阿马林激发试验的 BrS 阳性率。2008 年至 2019 年期间，所有连续接受阿马林测试的患者均前瞻性纳入。共有 2456 例患者接受了阿马林测试，其中 742 例（30.2%）为 BrS 家族筛查。在非家族筛查组（1714 例）中，186 例（10.9%）阿马林测试阳性。阿马林测试的适应证为：可疑 BrS 心电图 23 例（12.4%）、心悸 27 例（14.5%）、晕厥 71 例（38.2%）、先兆晕厥 7 例（3.8%）、家族性心源性猝死史 18 例（9.7%）、有记录的室性心律失常 12 例（6.5%）、不明原因心脏骤停 4 例（2.2%）、心房颤动 16 例（8.5%）、缓慢性心律失常 1 例（0.5%）和脑血管意外 7 例（3.7%）。与总体人群相比，阿马林测试阳性患者更年轻（42.8±15.5 岁 vs. 48.9±20.4 岁；p<0.001），且男性更多（65.1% vs. 56.3%；p=0.023）。84 例患者（45.2%）植入了植入式心脏复律除颤器。在中位数为 42.4 个月的随访期间，报告了 12 次适当电击和 13 次与植入式心脏复律除颤器相关的并发症。总之，在因各种心血管症状接受阿马林测试的患者中，BrS 的诊断比例出乎意料地高。这可以为 BrS 患者提供适当的咨询和临床管理。
