Belinda Gray1, Adrienne Kirby2, Peter Kabunga3, Saul B Freedman4, Laura Yeates5, Ajita Kanthan6, Caroline Medi1, Anthony Keech7, Christopher Semsarian1, Raymond W Sy8. 1. Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia; Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Camperdown, New South Wales, Australia. 2. Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia; NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia. 3. Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. 4. Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia; Department of Cardiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia; Heart Research Institute, Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia. 5. Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Camperdown, New South Wales, Australia. 6. Department of Cardiology, Blacktown Hospital, Blacktown, New South Wales, Australia. 7. Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia; NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia. 8. Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia; Department of Cardiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia. Electronic address: raymond.sy01@gmail.com.
Abstract
BACKGROUND: Patients with Brugada syndrome (BrS) are diagnosed and risk stratified on the basis of a spontaneous or drug-induced type 1 electrocardiographic (ECG) pattern, often at single time points not accounting for variation throughout the day. OBJECTIVES: The purpose of this study was to prospectively assess the overall burden of type 1 Brugada ECG changes using 12-lead 24-hour Holter monitoring and evaluate association with cardiac events. METHODS: From July 1, 2013 to December 31, 2015, patients with BrS were recruited from 3 Australian centers and the Australian Genetic Heart Disease Registry. All patients underwent clinical review, baseline ECG, and 12-lead 24-hour Holter assessment with precordial leads placed in the left and right second, third, and fourth intercostal spaces. The frequency, temporal, and spatial burden of type 1 BrS ECG pattern were analyzed and assessed for association with cardiac events. RESULTS: A total of 54 patients with BrS were recruited (n=44, 81% men; mean age 44 ± 13 years); the mean follow-up was 2.3 ± 2.5 years. Eleven of 32 patients (34%) initially classified as "drug-induced BrS" demonstrated a spontaneous type 1 pattern at least once over 24 hours. Patients with cardiac events had a significantly higher temporal burden of type 1 ST-segment elevation in the 24-hour monitoring period (total area under the curve 21% vs 15%; P = .008), being most pronounced between the hours of 1600 and 2400 (P = .027). CONCLUSION: Patients with BrS traditionally classified as drug-induced can exhibit spontaneous ECG changes with longer-term monitoring, particularly in the evening. Temporal burden on 12-lead Holter monitor was associated with cardiac events. Ambulatory 12-lead ECG monitoring may have potential utility in the diagnosis and risk stratification of patients with BrS.
BACKGROUND:Patients with Brugada syndrome (BrS) are diagnosed and risk stratified on the basis of a spontaneous or drug-induced type 1 electrocardiographic (ECG) pattern, often at single time points not accounting for variation throughout the day. OBJECTIVES: The purpose of this study was to prospectively assess the overall burden of type 1 Brugada ECG changes using 12-lead 24-hour Holter monitoring and evaluate association with cardiac events. METHODS: From July 1, 2013 to December 31, 2015, patients with BrS were recruited from 3 Australian centers and the Australian Genetic Heart Disease Registry. All patients underwent clinical review, baseline ECG, and 12-lead 24-hour Holter assessment with precordial leads placed in the left and right second, third, and fourth intercostal spaces. The frequency, temporal, and spatial burden of type 1 BrS ECG pattern were analyzed and assessed for association with cardiac events. RESULTS: A total of 54 patients with BrS were recruited (n=44, 81% men; mean age 44 ± 13 years); the mean follow-up was 2.3 ± 2.5 years. Eleven of 32 patients (34%) initially classified as "drug-induced BrS" demonstrated a spontaneous type 1 pattern at least once over 24 hours. Patients with cardiac events had a significantly higher temporal burden of type 1 ST-segment elevation in the 24-hour monitoring period (total area under the curve 21% vs 15%; P = .008), being most pronounced between the hours of 1600 and 2400 (P = .027). CONCLUSION:Patients with BrS traditionally classified as drug-induced can exhibit spontaneous ECG changes with longer-term monitoring, particularly in the evening. Temporal burden on 12-lead Holter monitor was associated with cardiac events. Ambulatory 12-lead ECG monitoring may have potential utility in the diagnosis and risk stratification of patients with BrS.
Authors: Jonathan M Daw; C Anwar A Chahal; Jeffrey S Arkles; David J Callans; Sanjay Dixit; Andrew E Epstein; David S Frankel; Fermin C Garcia; Matthew C Hyman; Ramanan Kumareswaran; David Lin; Saman Nazarian; Michael P Riley; Pasquale Santangeli; Robert D Schaller; Gregory E Supple; Cory Tschabrunn; Francis E Marchlinski; Rajat Deo Journal: Heart Rhythm O2 Date: 2022-02-08
Authors: Sharen Lee; Jiandong Zhou; Tong Liu; Konstantinos P Letsas; Sandeep S Hothi; Vassilios S Vassiliou; Guoliang Li; Adrian Baranchuk; Raymond W Sy; Dong Chang; Qingpeng Zhang; Gary Tse Journal: Front Physiol Date: 2020-09-03 Impact factor: 4.566
Authors: Belinda Gray; Ganesh Kumar Gnanappa; Richard D Bagnall; Giuseppe Femia; Laura Yeates; Jodie Ingles; Charlotte Burns; Rajesh Puranik; Stuart M Grieve; Christopher Semsarian; Raymond W Sy Journal: PLoS One Date: 2018-04-13 Impact factor: 3.240
Authors: Antonio Thomaz de Andrade; Raimundo Barbosa-Barros; Kjell Nikus; Rodrigo D Raimundo; Luiz C de Abreu; Luciana Sacilotto; Francisco C C Darriuex; Frank G Yanowitz; Pedro Brugada; Andrés Ricardo Pérez-Riera Journal: Ann Noninvasive Electrocardiol Date: 2021-12-09 Impact factor: 1.485