Copyright © 2002 by the European Society of Cardiology.
Electrophysiologic investigation in Brugada syndrome. Yield of programmed ventricular stimulation at two ventricular sites with up to three premature beats
a Hospital of the Westfälische Wilhelms-University, Department of Cardiology and Angiology and Institute for Arteriosclerosis Research, Münster, Germany
b University Hospital Mannheim, Mannheim, Germany
revised March 4, 2002; accepted March 13, 2002
Abstract
Introduction Numerous reports on the inducibility of ventricular tachyarrhythmias (VT) in patients with atypical right bundle branch block and right precordial ST-elevation (Brugada syndrome) are based on multicentre studies that have used different stimulation protocols. Therefore, we prospectively investigated the inducibility of VT in these patients using a uniform protocol.
Methods In 41 consecutive patients (29 males) showing a pattern of right bundle branch block and ST-elevation, programmed ventricular stimulation was performed in the right ventricular apex with up to three premature stimuli at sinus rhythm and at four different paced cycle lengths (500, 430, 370, and 330ms) until refractoriness was reached or reproducible induction of a sustained (>30s) VT occurred. If a VT was not reproducibly inducible, the same protocol was repeated in the right ventricular outflow tract.
Results A history of life-threatening events defined as syncope (n=17) or aborted sudden cardiac death (n=13) was present in 30 patients (73%); 11 individuals were asymptomatic. Inducibility (68%) was similar between symptomatic (n=21, 70%) and asymptomatic patients (n=7, 64%). In 16 (39%) patients, VT were reproducibly inducible. If patients were only stimulated in the right ventricular apex, inducibility rate decreased to 39%. If only two premature beats at two sites were used it was as low as 32%. The mean coupling intervals of the second and third premature stimuli inducing sustained VT were short: 189±21ms vs 186±22ms, respectively. Forty-four percent of all patients (i.e. 64% of the inducible patients) had inducible VT only with coupling intervals shorter than 200ms.
Conclusions The stimulation protocol markedly influences the extent of inducibility of VT in patients with right bundle branch block and ST-segment elevation. These findings question the significance of previous multicentre studies using different stimulation protocols and should have implications for further studies. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.
Key Words: Brugada syndrome, programmed ventricular stimulation
f1 Correspondence: Dr med. Lars Eckardt, Medizinische Klinik und Poliklinik C, Kardiologie–Angiologie, Universitätsklinikum Münster, Germany.
References
- Brugada P, Brugada J. Right bundle branch block, persistent ST segment elevation and sudden cardiac death: A distinct clinical and electrocardiographic syndrome. A multicenter report. J Am Coll Cardiol. 1992;20:1391–1396[Abstract]
- Brugada P, Geelen P, Brugada R, Mont L, Brugada J. Prognostic value of electrophysiologic investigations in Brugada syndrome. J Cardiovasc Electrophysiol. 2001;12:1004–1007[CrossRef][Web of Science][Medline]
- Brugada J, Brugada R, Antzelevitch C, Towbin J, Nademanee K, Brugada P. Long-term follow-up of individuals with the electrocardiographic pattern of right bundle branch block and ST-segment elevation in precordial leads V1 to V3. Circulation. 2002;105:73–78
[Abstract/Free Full Text] - Brugada J, Brugada R, Brugada P. Right bundle-branch block and ST-segment elevation in leads V-1 through V-3: A marker for sudden death in patients without demonstrable structural heart disease structural heart disease. Circulation. 1998;97:457–460
[Abstract/Free Full Text] - Priori SG, Napolitano C, Gasparini M. Clinical and genetic heterogeneity of right bundle branch block and ST-Segment elevation syndrome A prospective evaluation of 52 families. Circulation. 2000;102:2509–2515
[Abstract/Free Full Text] - Eckardt L, Kirchhof P, Loh P. Brugada syndrome and supraventricular tachyarrhythmias: a novel association? J Cardiovasc Electrophysiol. 2001;12:680–685[CrossRef][Web of Science][Medline]
- Nademanee K, Veerakul G, Nimmannit S. Arrhythmogenic marker for the sudden unexplained death syndrome in Thai men. Circulation. 1997;96:2595–2600
[Abstract/Free Full Text] - Kasanuki H, Ohnishi S, Ohtuka M. Idiopathic ventricular fibrillation induced with vagal activity in patients without obvious heart disease. Circulation. 1997;95:2277–2285
[Abstract/Free Full Text] - Kakishita M, Kurita T, Matsuo K. Mode of onset of ventricular fibrillation in patients with Brugada syndrome detected by implantable cardioverter defibrillator therapy. J Am Coll Cardiol. 2000;36:1646–1653
[Abstract/Free Full Text] - Carlsson J, Erdogan A, Schulte B, Neuzner J, Pitschner HF. Possible role of epicardial left ventricular programmed stimulation in Brugada syndrome. Pacing Clin Electrophysiol. 2001;24:247–249[CrossRef][Medline]
- Viskin S, Lesh MD, Eldar M. Mode of onset of malignant ventricular arrhythmias in idiopathic ventricular fibrillation. J Cardiovasc Electrophysiol. 1997;8:1115–1120[Web of Science][Medline]
- Antzelevitch C. The Brugada Syndrome. J Cardiovasc Electrophysiol. 1998;9:513–516[Web of Science][Medline]
- Yan GX, Antzelevitch C. Cellular basis for the Brugada syndrome and other mechanisms of arrhythmogenesis associated with ST-segment elevation. Circulation. 1999;100:1660–1666
[Abstract/Free Full Text] - Eckardt, L, Bruns, H, Kirchhof, P, Body surface area of ST-elevation and presence of late potentials correlate to the inducibility of ventricular tachyarrhythmias in Brugada syndrome, J Cardiovasc Electrophysiol
- Bruns J, Eckardt L, Vahlhaus C. Body surface potential mapping in patients with Brugada syndrome: right precordial ST segment variations and reverse changes in left precordial leads. Cardiovasc Res. 2002;54:58–66
[Abstract/Free Full Text]
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  S. Zumhagen, T. Spieker, J. Rolinck, H. A. Baba, G. Breithardt, W. Bocker, L. Eckardt, M. Paul, T. Wichter, and E. Schulze-Bahr Absence of Pathognomonic or Inflammatory Patterns in Cardiac Biopsies From Patients With Brugada Syndrome Circ Arrhythm Electrophysiol, February 1, 2009; 2(1): 16 - 23. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Paul, J. Gerss, E. Schulze-Bahr, T. Wichter, C. Vahlhaus, A. A.M. Wilde, G. Breithardt, and L. Eckardt Role of programmed ventricular stimulation in patients with Brugada syndrome: a meta-analysis of worldwide published data Eur. Heart J., September 1, 2007; 28(17): 2126 - 2133. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Viskin and O. Rogowski Asymptomatic Brugada syndrome: a cardiac ticking time-bomb? Europace, September 1, 2007; 9(9): 707 - 710. [Full Text] [PDF]
|
|
|
|
 |
|
 E. A. Stephenson and C. I. Berul Electrophysiological Interventions for Inherited Arrhythmia Syndromes Circulation, August 28, 2007; 116(9): 1062 - 1080. [Full Text] [PDF]
|
|
|
|
|
|
P. Brugada, R. Brugada, J. Brugada, S. G. Priori, C. Napolitano, P. Brugada, R. Brugada, J. Brugada, S. G. Priori, and C. Napolitano Should patients with an asymptomatic Brugada electrocardiogram undergo pharmacological and electrophysiological testing? Circulation, July 12, 2005; 112(2): 279 - 292. [Full Text] [PDF]
|
|
|
|
|
|
C. Antzelevitch, P. Brugada, M. Borggrefe, J. Brugada, R. Brugada, D. Corrado, I. Gussak, H. LeMarec, K. Nademanee, A. R. Perez Riera, et al. Brugada Syndrome: Report of the Second Consensus Conference: Endorsed by the Heart Rhythm Society and the European Heart Rhythm Association Circulation, February 8, 2005; 111(5): 659 - 670. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Eckardt, V. Probst, J. P.P. Smits, E. S. Bahr, C. Wolpert, R. Schimpf, T. Wichter, P. Boisseau, A. Heinecke, G. Breithardt, et al. Long-Term Prognosis of Individuals With Right Precordial ST-Segment-Elevation Brugada Syndrome Circulation, January 25, 2005; 111(3): 257 - 263. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Kies, T. Wichter, M. Schafers, M. Paul, K. P. Schafers, L. Eckardt, L. Stegger, E. Schulze-Bahr, O. Rimoldi, G. Breithardt, et al. Abnormal Myocardial Presynaptic Norepinephrine Recycling in Patients With Brugada Syndrome Circulation, November 9, 2004; 110(19): 3017 - 3022. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Belhassen, A. Glick, and S. Viskin Efficacy of Quinidine in High-Risk Patients With Brugada Syndrome Circulation, September 28, 2004; 110(13): 1731 - 1737. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.-S. Hermida, I. Denjoy, J. Clerc, F. Extramiana, G. Jarry, P. Milliez, P. Guicheney, S. Di Fusco, J.-L. Rey, B. Cauchemez, et al. Hydroquinidine therapy in Brugada syndrome J. Am. Coll. Cardiol., May 19, 2004; 43(10): 1853 - 1860. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Bordachar, S. Reuter, S. Garrigue, X. Cai, M. Hocini, P. Jais, M. Haissaguerre, and J. Clementy Incidence, clinical implications and prognosis of atrial arrhythmias in brugada syndrome Eur. Heart J., May 2, 2004; 25(10): 879 - 884. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-S. Hermida, A. Leenhardt, B. Cauchemez, I. Denjoy, G. Jarry, F. Mizon, P. Milliez, J.-L. Rey, P. Beaufils, and P. Coumel Decreased nocturnal standard deviation of averaged NN intervals: An independent marker to identify patients at risk in the Brugada Syndrome Eur. Heart J., November 2, 2003; 24(22): 2061 - 2069. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Rolf, H.-J. Bruns, T. Wichter, P. Kirchhof, M. Ribbing, K. Wasmer, M. Paul, G. Breithardt, W. Haverkamp, and L. Eckardt The ajmaline challenge in Brugada syndrome: Diagnostic impact, safety, and recommended protocol Eur. Heart J., June 2, 2003; 24(12): 1104 - 1112. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||