Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan.
Department of Medicine II, Kansai Medical University, Moriguchi, Japan.
Ann Noninvasive Electrocardiol. 2021 Jul;26(4):e12831. doi: 10.1111/anec.12831. Epub 2021 Feb 19.
Brugada syndrome (BrS) is diagnosed in patients with ST-segment elevation with spontaneous, drug-induced, or fever-induced type 1 morphology. Prognosis in type 2 or 3 Brugada electrocardiogram (Br-ECG) patients remains unknown. The purpose of this study is to evaluate long-term prognosis in non-type 1 Br-ECG patients in a large Japanese cohort of idiopathic ventricular fibrillation (The Japan Idiopathic Ventricular Fibrillation Study [J-IVFS]).
From 567 patients with Br-ECG in J-IVFS, a total of 28 consecutive non-type 1 patients who underwent programmed electrical stimulation (PES) (median age: 58 years, all male, previous sustained ventricular tachyarrhythmias [VTs] 1, syncope 11, asymptomatic 16) were enrolled. Cardiac events (CEs: sudden cardiac death or sustained VT/ventricular fibrillation) during the follow-up period were examined.
During a median follow-up of 136 months, four patients (14%) had CEs. None of patients with PES- have experienced CEs. There was no statistically significant clinical risk factor for the development of CEs. Using the Kaplan-Meier method, the event-free rate significantly decreased in a group with all 3 risk factors (symptom, wide QRS complex in lead V , and positive PES) (p = .01).
Our study revealed long-term prognosis in patients with non-type 1 Br-ECG. The combination analysis of these risk factors may be useful for the risk stratification of CEs in non-type 1 Br-ECG patients. The present study suggests that the patients with all these parameters showed high risk for CEs and need to be carefully followed.
Brugada 综合征（BrS）的诊断标准为伴有自发性、药物诱导或发热诱导的 1 型形态的 ST 段抬高。2 型或 3 型 Brugada 心电图（Br-ECG）患者的预后仍不清楚。本研究的目的是评估大型日本特发性心室颤动（日本特发性心室颤动研究 [J-IVFS]）中无 1 型 Br-ECG 的非 1 型 Br-ECG 患者的长期预后。
从 J-IVFS 中 Br-ECG 的 567 例患者中，共纳入 28 例连续非 1 型患者（中位年龄：58 岁，均为男性，既往持续性室性心动过速/心室颤动 [VTs] 1 例，晕厥 11 例，无症状 16 例），接受程控电刺激（PES）。检查随访期间的心脏事件（CEs：心源性猝死或持续性 VT/室颤）。
在中位随访 136 个月期间，有 4 例患者（14%）发生 CEs。PES 患者无一例发生 CEs。无统计学意义的临床危险因素可预测 CEs 的发生。Kaplan-Meier 法显示，在具有所有 3 个危险因素（症状、V 导联宽 QRS 波群和阳性 PES）的组中，无事件生存率显著降低（p=0.01）。
本研究揭示了非 1 型 Br-ECG 患者的长期预后。这些危险因素的联合分析可能有助于非 1 型 Br-ECG 患者的 CEs 风险分层。本研究表明，具有所有这些参数的患者发生 CEs 的风险较高，需要密切随访。
