Yonezu Keisuke, Shinohara Tetsuji, Takahashi Masaki, Harada Taisuke, Mitarai Kazuki, Takano Masayuki, Hirota Kei, Abe Ichitaro, Kondo Hidekazu, Fukui Akira, Akioka Hidefumi, Teshima Yasushi, Takahashi Naohiko
Department of Cardiology and Clinical Examination, Faculty of Medicine Oita University Oita Japan.
J Arrhythm. 2025 Aug 6;41(4):e70164. doi: 10.1002/joa3.70164. eCollection 2025 Aug.
Risk stratification for ventricular fibrillation (VF) in patients with Brugada syndrome (BrS) remains a significant clinical challenge. Atrial fibrillation (AF) is relatively common in BrS, suggesting arrhythmogenic abnormalities in both the atria and ventricles. The purpose of this study was to investigate the relationship between P-waveforms and VF occurrence in patients with BrS.
Eighty-two patients with BrS were retrospectively evaluated and classified into two groups based on the occurrence of VF during the overall clinical course: VF occurrence ( = 34) and VF nonoccurrence ( = 48). The relationship between VF occurrence and parameters on 12-lead electrocardiogram (ECG) at the initial visit, prior to any drug administration, was analyzed.
During a median follow-up of 75.0 months, VF occurred in 23 patients, including 19 recurrent and four new cases. Multivariable logistic regression identified notched P-wave as an independent risk factor for VF occurrence in all models (odds ratios 6.45-8.45; all < 0.01). Depending on the model, symptomatic BrS, early repolarization pattern, and fragmented QRS were also independently associated with VF. Kaplan-Meier analysis showed a significantly lower incidence of VF in patients with BrS who have neither a history of VF nor a notched P-wave ( < 0.0001).
Notched P-wave on 12-lead ECG is a significant risk factor for the occurrence of VF in patients with BrS. Notched P-wave in patients with BrS may indicate the presence of an underlying arrhythmogenic substrate predisposing to VF.
对 Brugada 综合征（BrS）患者的室颤（VF）进行风险分层仍然是一项重大的临床挑战。房颤（AF）在 BrS 中相对常见，提示心房和心室均存在致心律失常异常。本研究的目的是探讨 BrS 患者 P 波形态与 VF 发生之间的关系。
对 82 例 BrS 患者进行回顾性评估，并根据整个临床过程中 VF 的发生情况分为两组：VF 发生组（n = 34）和 VF 未发生组（n = 48）。分析了初次就诊时、在任何药物治疗之前 12 导联心电图（ECG）参数与 VF 发生之间的关系。
在中位随访 75.0 个月期间，23 例患者发生了 VF，包括 19 例复发和 4 例新发病例。多变量逻辑回归分析在所有模型中均确定切迹 P 波是 VF 发生的独立危险因素（比值比 6.45 - 8.45；均 P < 0.01）。根据模型不同，有症状的 BrS、早期复极模式和碎裂 QRS 也与 VF 独立相关。Kaplan-Meier 分析显示，既无 VF 病史也无切迹 P 波的 BrS 患者 VF 发生率显著较低（P < 0.0001）。
12 导联 ECG 上的切迹 P 波是 BrS 患者发生 VF 的重要危险因素。BrS 患者的切迹 P 波可能表明存在易导致 VF 的潜在致心律失常基质。
