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European Heart Journal 2003 24(22):2061-2069; doi:10.1016/j.ehj.2003.08.019
Copyright © 2003 by the European Society of Cardiology.
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Clinical research

Decreased nocturnal standard deviation of averaged NN intervals

An independent marker to identify patients at risk in the Brugada Syndrome

Jean-Sylvain Hermidaa,*, Antoine Leenhardtb, Bruno Cauchemezb, Isabelle Denjoyb,d, Geneviève Jarrya, Fréderique Mizonc, Paul Milliezb, Jean-Luc Reya, Philippe Beaufilsb and Philippe Coumelb

a Centre Hospitalier Universitaire,Amiens, France
b Hôpital Lariboisière, Paris, France
c Centre Hospitalier Universitaire, Lille, France
d INSERM U582, Hôpital Pitié Salpêtrière, Paris, France

* Correspondence to: Dr JS Hermida. Service de cardiologie A, Hôpital Sud, Centre Hospitalier Universitaire d'Amiens-Picardie. F-80054 Amiens Cedex, France. Tel: +33 322 45 60 00. Fax: +33 322 45 56 61
E-mail address: hermida.jean-sylvain{at}chu-amiens.fr

Received 15 May 2003; revised 8 August 2003; accepted 14 August 2003

Abstract

Aims Risk-stratification of asymptomatic Brugada Syndrome (BS) patients remains a key-issue. A typical spontaneous BS-ECG pattern and ventricular tachycardia (VT)/ventricular fibrillation (VF) inducibility are two recognized risk markers. The aim of the study was to identify additional risk markers in asymptomatic BS.

Methods and results We have compared Holter recordings in symptomatic and in asymptomatic patients with BS. Heart rate variability (HRV), QT-interval rate-dependence and ST-segment elevation (ST-SE) were analysed. The study population included 47 BS patients (M=36, mean age=45±13 years) with a malignant ventricular arrhythmia in 11 cases, an unexplained syncope in 10 cases and no symptoms in the remaining 26 cases. A typical spontaneous BS-ECG was present in 21 cases and a drug-induced BS-ECG in 26 cases. A downward trend of the time domain variables of HRV was observed. During the nocturnal period, standard deviation (SD) of the 5min averaged NN intervals (SDANN) (46±13 vs 57±18ms, P=0.02) and ultra low frequency component (3287±2312 vs 5030±3270 ms2, P=0.04) were significantly lower in symptomatic versus asymptomatic patients. In contrast, no difference was found in QT-interval rate dependence and in ST-SE. At multivariate logistic regression, VT/VF inducibility, typical spontaneous BS-ECG and a decreased nocturnal SDANN were associated with arrhythmic events (P=0.003).

Conclusion A decreased nocturnal SDANN was an independent marker of arrhythmic events in these BS patients.

Key Words: Arrhythmia • Genetics • Sudden death • Prevention


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