Copyright © 1999 by the European Society of Cardiology.
The circadian pattern of the development of ventricular fibrillation in patients with Brugada syndrome
Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center, Osaka, Japan
revised September 25, 1998; accepted September 30, 1998
Abstract
Aims
Brugada syndrome is considered to be a distinctive subgroup of idiopathic ventricular fibrillation. Identification of the circadian pattern of ventricular fibrillation would contribute to the elucidation of its underlying pathophysiology, but this pattern remains unknown in patients with Brugada syndrome.
Methods and Results
A total of 12 consecutive Brugada syndrome patients (46±14 years, all male) who underwent implantation of an implantable cardioverter–defibrillator were studied. The distribution of the time of ventricular fibrillation detection was examined and classified into four 6-hour time periods of the day. The mean follow-up period following implantation was 777±535 days. In six out of the 12 patients, ventricular fibrillation occurred during follow-up. The data logs revealed that ventricular fibrillation was detected 30 times (range, 3–9). Ventricular fibrillation was observed more frequently at night (1800h to 0600h) than in the day (0600h to 1800h) (93·3% [28/30] vs 6·7% [2/30],P<0·001), and during sleep than while awake (86·7% [26/30] vs 13·3% [4/30],P<0·001). Ventricular fibrillation occurred most frequently between midnight and 0600h in patients with ventricular fibrillation episodes during sleep (76·9% [20/26] vs 23·1% [6/26],P<0·01).
Conclusion
These results suggest that increased nocturnal vagal activity and withdrawal sympathetic activity may play an important role in the arrhythmogenesis of the Brugada syndrome.
Key Words: Idiopathic ventricular fibrillation, circadian pattern, implantable cardioverter–defibrillator
f1 Correspondence: Kiyotaka Matsuo, MD, Third Department of Internal Medicine, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
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