Camkiran Volkan, Ozden Ozge, Atar Ilyas
Department of Cardiology, Goztepe Medicalpark Hospital, Istanbul, Turkey.
Department of Cardiology, Memorial Bahcelievler Hospital, Istanbul, Turkey.
Medicine (Baltimore). 2024 May 3;103(18):e37990. doi: 10.1097/MD.0000000000037990.
Brugada syndrome (BS) is characterized by ST segment elevation in right precordial leads (V1-V3), ventricular tachycardia (VT), ventricular fibrillation (VF), and sudden cardiac death (SCD) in individuals without structural heart disease. The aim of this study is to contribute to the controversial issue of finding the most valuable marker that can predict poor prognosis during follow-up in patients with a diagnosis of BS. A total of 68 patients diagnosed with BS or had Brugada-type ECG change between January 1997 and July 2012 at the Department of Cardiology of Başkent University Faculty of Medicine, Ankara, Turkey, were included in this cohort study. Patients were screened every 6 months for arrhythmia-related syncope, SCD, appropriate and inappropriate defibrillation (shock), AF development and death; collectively defined as "arrhythmic events" and were the primary endpoints. Patients with and without arrhythmic events were compared. The mean age was 34.9 ± 12.2 years (9-71 years), and 52 (76.5%) patients were male. Mean follow-up was 49.6 ± 37.6 months (4-188 months). Univariate analysis showed that male sex (P = .004), type 1 electrocardiographic pattern (P = .008), SCD (P = .036), VT/VF history (P = .046), requirement for electrophysiological studies (P = .034), implantable cardioverter-defibrillator placement (P = .014) were found to demonstrate significant differences in patients with and without arrhythmic events. In multivariable analyzes, spontaneous type 1 ECG presence (HR = 8.54, 95% CI: 0.38-26.37; P = .003) and VT/VF history (HR = 9.21, 95% CI: 0.004-1.88; P = .002) were found to be independently associated with arrhythmic events. We found the presence of spontaneous type 1 ECG and a history of VT/VF to be associated with increased likelihood of overall arrhythmic events in BS. Given the higher risk of poor prognosis, we recommend additional measures in patients with BS who have these features.
布加综合征（BS）的特征是在无结构性心脏病的个体中，右胸前导联（V1-V3）出现ST段抬高、室性心动过速（VT）、室颤（VF）和心源性猝死（SCD）。本研究的目的是探讨一个有争议的问题，即寻找最有价值的标志物，以预测诊断为BS的患者随访期间的不良预后。本队列研究纳入了1997年1月至2012年7月期间在土耳其安卡拉巴什肯特大学医学院心脏病科诊断为BS或有Brugada型心电图改变的68例患者。每6个月对患者进行一次筛查，以检查是否有心律失常相关的晕厥、SCD、适当和不适当的除颤（电击）、房颤发生及死亡情况；这些情况统称为“心律失常事件”，是主要终点。对发生和未发生心律失常事件的患者进行比较。患者的平均年龄为34.9±12.2岁（9-71岁），52例（76.5%）为男性。平均随访时间为49.6±37.6个月（4-188个月）。单因素分析显示，男性（P=.004）、1型心电图模式（P=.008）、SCD（P=.036）、VT/VF病史（P=.046）、电生理检查需求（P=.034）、植入式心脏复律除颤器植入（P=.014）在发生和未发生心律失常事件的患者中存在显著差异。在多变量分析中，发现自发出现1型心电图（HR=8.54，95%CI：0.38-26.37；P=.003）和VT/VF病史（HR=9.21，95%CI：0.004-1.88；P=.002）与心律失常事件独立相关。我们发现，自发出现1型心电图和VT/VF病史与BS患者总体心律失常事件发生可能性增加有关。鉴于预后不良风险较高，我们建议对有这些特征的BS患者采取额外措施。
