Yuka Mizusawa1, Hiroshi Morita2, Arnon Adler3, Ofer Havakuk3, Aurélie Thollet4, Philippe Maury5, Dao W Wang6, Kui Hong7, Estelle Gandjbakhch8, Frédéric Sacher9, Dan Hu10, Ahmad S Amin1, Najim Lahrouchi1, Hanno L Tan1, Charles Antzelevitch11, Vincent Probst4, Sami Viskin3, Arthur A M Wilde12. 1. Heart Centre, Department of Clinical and Experimental Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. 2. Department of Cardiovascular Medicine, Okayama University of Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. 3. Department of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. 4. INSERM, UMR 1087, Institut du thorax, Université de Nantes, Nantes, France; CNRS, UMR 6291, Institut du thorax, Université de Nantes, Nantes, France. 5. University Hospital Rangueil, Toulouse, France. 6. Department of Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China. 7. Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Nanchang, China. 8. UPMC, University Paris 6, INSERM, UMRS 956, Institut de Cardiologie (AP-HP), Paris, France; AP-HP, Hôpital Pitié-Salpêtrière, Paris, France. 9. Bordeaux University Hospital, IHU Institut de Rythmologie et Modélisation Cardiaque, Inserm U1045, Université de Bordeaux, Bordeaux, France. 10. Masonic Medical Rearch Laboratory, Utica, New York. 11. Lankenau Institute for Medical Research, Wynnewood, Pennsylvania. 12. Heart Centre, Department of Clinical and Experimental Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. Electronic address: a.a.wilde@amc.uva.nl.
Abstract
BACKGROUND: In Brugada syndrome (BrS), spontaneous type 1 electrocardiogram (ECG) is an established risk marker for fatal arrhythmias whereas drug-induced type 1 ECG shows a relatively benign prognosis. No study has analyzed the prognosis of fever-induced type 1 ECG (F-type1) in a large BrS cohort. OBJECTIVES: The objectives of this study were to assess the prognosis of F-type1 in asymptomatic BrS and to compare the effects of fever and drugs on ECG parameters. METHODS: One hundred twelve patients with BrS who developed F-type1 were retrospectively enrolled. Prognosis was evaluated in 88 asymptomatic patients. In a subgroup (n = 52), ECG parameters of multiple ECGs (at baseline, during fever, and after drug challenge) were analyzed. RESULTS: Eighty-eight asymptomatic patients had a mean age of 45.8 ± 18.7 years, and 71.6% (67 of 88) were men. Twenty-one percent (18 of 88) had a family history of sudden cardiac death, and 26.4% (14 of 53) carried a pathogenic SCN5A mutation. Drug challenge was positive in 29 of 36 patients tested (80.6%). The risk of ventricular fibrillation in asymptomatic patients was 0.9%/y (3 of 88; 43.6 ± 37.4 months). ST-segment elevation in lead V2 during fever and after drug challenge was not significantly different (0.41 ± 0.21 ms during fever and 0.40 ± 0.30 ms after drug challenge; P > .05). Fever shortened the PR interval compared to baseline, whereas drug challenge resulted in prolonged PR interval and QRS duration (PR interval: 169 ± 29 ms at baseline, 148 ± 45 ms during fever, and 202 ± 35 ms after drug challenge; QRS duration: 97 ± 18 ms at baseline, 92 ± 28 ms during fever, and 117 ± 21 ms after drug challenge). CONCLUSION: Patients with BrS who develop F-type1 are at risk of arrhythmic events. F-type1 appears to develop through a more complex mechanism as compared with drug-induced type 1 ECG.
BACKGROUND: In Brugada syndrome (BrS), spontaneous type 1 electrocardiogram (ECG) is an established risk marker for fatal arrhythmias whereas drug-induced type 1 ECG shows a relatively benign prognosis. No study has analyzed the prognosis of fever-induced type 1 ECG (F-type1) in a large BrS cohort. OBJECTIVES: The objectives of this study were to assess the prognosis of F-type1 in asymptomatic BrS and to compare the effects of fever and drugs on ECG parameters. METHODS: One hundred twelve patients with BrS who developed F-type1 were retrospectively enrolled. Prognosis was evaluated in 88 asymptomatic patients. In a subgroup (n = 52), ECG parameters of multiple ECGs (at baseline, during fever, and after drug challenge) were analyzed. RESULTS: Eighty-eight asymptomatic patients had a mean age of 45.8 ± 18.7 years, and 71.6% (67 of 88) were men. Twenty-one percent (18 of 88) had a family history of sudden cardiac death, and 26.4% (14 of 53) carried a pathogenic SCN5A mutation. Drug challenge was positive in 29 of 36 patients tested (80.6%). The risk of ventricular fibrillation in asymptomatic patients was 0.9%/y (3 of 88; 43.6 ± 37.4 months). ST-segment elevation in lead V2 during fever and after drug challenge was not significantly different (0.41 ± 0.21 ms during fever and 0.40 ± 0.30 ms after drug challenge; P > .05). Fever shortened the PR interval compared to baseline, whereas drug challenge resulted in prolonged PR interval and QRS duration (PR interval: 169 ± 29 ms at baseline, 148 ± 45 ms during fever, and 202 ± 35 ms after drug challenge; QRS duration: 97 ± 18 ms at baseline, 92 ± 28 ms during fever, and 117 ± 21 ms after drug challenge). CONCLUSION:Patients with BrS who develop F-type1 are at risk of arrhythmic events. F-type1 appears to develop through a more complex mechanism as compared with drug-induced type 1 ECG.
Authors: Zhong-He Zhang; Hector Barajas-Martínez; Hao Xia; Bian Li; John A Capra; Jerome Clatot; Gan-Xiao Chen; Xiu Chen; Bo Yang; Hong Jiang; Gary Tse; Yoshiyasu Aizawa; Michael H Gollob; Melvin Scheinman; Charles Antzelevitch; Dan Hu Journal: J Am Coll Cardiol Date: 2021-10-19 Impact factor: 27.203
Authors: Peter J Schwartz; Michael J Ackerman; Charles Antzelevitch; Connie R Bezzina; Martin Borggrefe; Bettina F Cuneo; Arthur A M Wilde Journal: Nat Rev Dis Primers Date: 2020-07-16 Impact factor: 52.329