Lee Sharen, Zhou Jiandong, Liu Tong, Letsas Konstantinos P, Hothi Sandeep S, Vassiliou Vassilios S, Li Guoliang, Baranchuk Adrian, Sy Raymond W, Chang Dong, Zhang Qingpeng, Tse Gary
Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Hong Kong, China.
School of Data Science, City University of Hong Kong, Hong Kong, China.
Front Physiol. 2020 Sep 3;11:953. doi: 10.3389/fphys.2020.00953. eCollection 2020.
Patients with Brugada electrocardiographic (ECG) patterns have differing levels of arrhythmic risk. We hypothesized that temporal variations in certain ECG markers may provide additional value for risk stratification. The present study evaluated the relationship between temporal variability of ECG markers and arrhythmic outcomes in patients with a Brugada pattern ECG. Comparisons were made between low-risk asymptomatic subjects versus high-risk symptomatic patients with a history of syncope, ventricular tachycardia (VT) or ventricular fibrillation (VF).
A total of 81 patients presenting with Brugada patterns were recruited. Serial ECGs and electronic health records from January 2004 to April 2019 were analyzed. Temporal variability of QRS interval, J point-T interval (JTp), T-T interval (Tp-e), and ST elevation (STe) in precordial leads V1-3, in addition to RR-interval from lead II, was assessed using standard deviation and difference between maximum and minimum values over the serial ECGs.
Patients presenting with type 1 Brugada ECG pattern initially had significantly higher variability in JTp from lead V2 (SD: 33.5 ± 13.8 vs. 25.2 ± 11.5 ms, = 0.009; max-min: 98.6 ± 46.2 vs. 78.3 ± 47.6 ms, = 0.047) and ST elevation in lead V1 (0.117 ± 0.122 vs. 0.053 ± 0.030 mV; = 0.004). Significantly higher variability in Tp-e interval measured from lead V3 was observed in the VT/VF group compared to the syncope and asymptomatic groups (SD: 20.5 ± 8.5 vs. 16.6 ± 7.3 and 14.7 ± 9.8 ms; = 0.044; max-min: 70.2 ± 28.9 vs. 56.3 ± 29.0 and 43.5 ± 28.5 ms; = 0.011).
Temporal variability in ECG indices may provide additional value for risk stratification in patients with Brugada pattern.
具有Brugada心电图（ECG）模式的患者心律失常风险水平各不相同。我们假设某些ECG标志物的时间变化可能为风险分层提供额外价值。本研究评估了ECG标志物的时间变异性与Brugada模式ECG患者心律失常结局之间的关系。对低风险无症状受试者与有晕厥、室性心动过速（VT）或室颤（VF）病史的高风险有症状患者进行了比较。
共招募了81例表现出Brugada模式的患者。分析了2004年1月至2019年4月的系列心电图和电子健康记录。使用系列心电图上的标准差以及最大值与最小值之间的差值，评估胸前导联V1 - 3中QRS间期、J点 - T间期（JTp）、T - T间期（Tp - e）和ST段抬高（STe）的时间变异性，以及II导联的RR间期。
最初表现为1型Brugada心电图模式的患者，V2导联的JTp变异性显著更高（标准差：33.5±13.8 vs. 25.2±11.5毫秒，P = 0.009；最大值 - 最小值：98.6±46.2 vs. 78.3±47.6毫秒，P = 0.047），V1导联的ST段抬高也更高（0.117±0.122 vs. 0.053±0.030毫伏；P = 0.004）。与晕厥组和无症状组相比，VT/VF组中从V3导联测量的Tp - e间期变异性显著更高（标准差：20.5±8.5 vs. 16.6±7.3和14.7±9.8毫秒；P = 0.044；最大值 - 最小值：70.2±28.9 vs. 56.3±29.0和43.5±28.5毫秒；P = 0.011）。
ECG指标的时间变异性可能为Brugada模式患者的风险分层提供额外价值。
