Pereira Eduardo Nolla Silva, Sacilotto Luciana, Wu Tan Chen, D'Arezzo Pessente Gabriele, Tessariol Hachul Denise, Scanavacca Mauricio Ibrahim, Darrieux Francisco Carlos da Costa
Instituto do Coração ‒ (InCor), Faculdade de Medicina, Hospital das Clínicas da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
Instituto do Coração ‒ (InCor), Faculdade de Medicina, Hospital das Clínicas da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
Clinics (Sao Paulo). 2025 Apr 4;80:100647. doi: 10.1016/j.clinsp.2025.100647. eCollection 2025.
Brugada Syndrome (BrS) typically manifests with a dynamic type 1 Brugada pattern (Br1ECGp) that depends on the dominance of the sympathetic or parasympathetic nervous system. This pattern is more prominent during activities that stimulate the vagus nerve, such as sleeping and after meals. By conducting the tilt table test and adding high precordial leads to the standard protocol, it is possible to provoke sympathetic or parasympathetic responses, providing valuable information.
This was an observational, cross-sectional and hypothesis-generating pilot study. The tilt table test was performed with high precordial leads on three Brugada patients to assess the Br1ECGp during the test. The ECG features were continuously recorded to analyze variations during all phases of the test.
The first patient exhibited a significant Br1ECGp that disappeared during the upward phase of the tilt table test and reappeared during the recovery phase. The second patient had a Br1ECGp in three leads that persisted during both the upward and recovery phases of the tilt table test. The third patient displayed a Br1ECGp in three leads, which was maintained during the upward phase in two leads and recovered during the recovery phase. The third patient was the only one to experience cardioinhibitory syncope.
This study provided insights into the dynamics of the Br1ECGp during the tilt table test when enhanced by high precordial leads. It reaffirmed that the Brugada ECG pattern is influenced by sympathetic or parasympathetic dominance.
Brugada综合征（BrS）通常表现为动态的1型Brugada图形（Br1ECGp），其取决于交感神经系统或副交感神经系统的优势。这种图形在刺激迷走神经的活动期间更为突出，例如睡眠和饭后。通过进行倾斜试验并在标准方案中增加高位胸前导联，可以激发交感或副交感反应，提供有价值的信息。
这是一项观察性、横断面和产生假设的试点研究。对三名Brugada患者进行了带有高位胸前导联的倾斜试验，以评估试验期间的Br1ECGp。连续记录心电图特征以分析试验各阶段的变化。
第一名患者表现出明显的Br1ECGp，在倾斜试验的上升阶段消失，并在恢复阶段重新出现。第二名患者在三个导联中出现Br1ECGp，在倾斜试验的上升阶段和恢复阶段均持续存在。第三名患者在三个导联中显示出Br1ECGp，其中两个导联在上升阶段保持不变，在恢复阶段恢复。第三名患者是唯一经历心脏抑制性晕厥的患者。
本研究深入了解了在高位胸前导联增强的情况下倾斜试验期间Br1ECGp的动态变化。它再次证实Brugada心电图图形受交感或副交感优势的影响。
