Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium; Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy. Electronic address: https://twitter.com/AntBisignani_MD.
Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium. Electronic address: https://twitter.com/LuigipannoneM.
JACC Clin Electrophysiol. 2023 Oct;9(10):2096-2105. doi: 10.1016/j.jacep.2023.06.011. Epub 2023 Aug 9.
Patients with Brugada syndrome (BrS) have an increased risk of arrhythmias, including atrial tachyarrhythmias (ATas).
The purpose of this study was to assess underlying atrial cardiomyopathy in BrS and the effect of ajmaline (AJM) test on the atrium of BrS patients using electrocardiogram imaging (ECGI).
All consecutive patients diagnosed with BrS in a monocentric registry were screened and included if they met the following criteria: 1) BrS diagnosed following current recommendations; and 2) ECGI map performed before and after AJM with a standard protocol. Consecutive patients with no structural heart disease or BrS who had undergone ECGI were included as a control group. Genetic analysis for SCN5A was performed in all BrS patients. Total atrial conduction time (TACT) and local atrial conduction time (LACT) were calculated from atrial ECGI. The primary endpoint was ATas during follow-up.
Forty-three consecutive BrS patients and 40 control patients were included. Both TACT and LACT were significantly prolonged in BrS patients compared with control patients. Furthermore, TACT and LACT were significantly higher after AJM administration and in BrS patients who were carriers of a pathogenic/likely pathogenic SCN5A variant. After a mean follow-up of 40.9 months, 6 patients experienced a first ATa occurrence (all in the BrS group, 13.9%). TACT was the only independent predictor of ATas with a cutoff of >138.5 ms (sensitivity 0.92 [95% CI: 0.83-0.98], specificity 0.70 [95% CI: 0.59-0.81]).
ECGI-calculated TACT and LACT are significantly prolonged in BrS patients compared with control patients, and in BrS patients after AJM. This may be consistent with a concealed atrial cardiomyopathy in BrS.
Brugada 综合征（BrS）患者心律失常风险增加，包括房性心动过速（ATas）。
本研究旨在评估 BrS 患者的潜在心房心肌病，并使用心电图成像（ECGI）评估 BrS 患者在用阿杰马琳（AJM）测试后的心房情况。
在一个单中心注册中心筛查并纳入符合以下标准的连续 BrS 患者：1）符合当前推荐标准诊断的 BrS；2）使用标准方案进行 AJM 前后的 ECGI 图谱。纳入无结构性心脏病或 BrS 且已进行 ECGI 的连续患者作为对照组。对所有 BrS 患者进行 SCN5A 基因分析。从心房 ECGI 计算总心房传导时间（TACT）和局部心房传导时间（LACT）。主要终点是随访期间的 ATas。
纳入 43 例连续 BrS 患者和 40 例对照组患者。与对照组患者相比，BrS 患者的 TACT 和 LACT 均显著延长。此外，在 AJM 给药后和携带致病性/可能致病性 SCN5A 变异的 BrS 患者中，TACT 和 LACT 更高。平均随访 40.9 个月后，6 例患者发生首次 ATa 发作（均在 BrS 组，13.9%）。TACT 是 ATas 的唯一独立预测因子，截断值>138.5ms（敏感性 0.92 [95%CI：0.83-0.98]，特异性 0.70 [95%CI：0.59-0.81]）。
与对照组患者相比，BrS 患者的 ECGI 计算的 TACT 和 LACT 显著延长，且在 BrS 患者在用 AJM 后延长。这可能与 BrS 患者隐匿性心房心肌病一致。
