Dylan Therasse1, Frederic Sacher2, Bertrand Petit3, Dominique Babuty4, Philippe Mabo5, Raphael Martins5, Laurence Jesel6, Philippe Maury7, Jean Luc Pasquie8, Jacques Mansourati9, Jean Marc Dupuis10, Florence Kyndt11, Aurélie Thollet1, Beatrice Guyomarch1, Julien Barc12, Jean Jacques Schott1, Herve Le Marec1, Richard Redon1, Vincent Probst1, Jean-Baptiste Gourraud13. 1. l'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France. 2. CHU Bordeaux, Hôpital cardiologique, Bordeaux, France. 3. CHR La Réunion, Service de Cardiologie, Saint Pierre, France. 4. CHU Tours, Service de Cardiologie, Tours, France. 5. CHU Rennes, Service de Cardiologie, Rennes, France. 6. CHU Strasbourg, Service de Cardiologie, Strasbourg, France. 7. CHU Toulouse, Service de Cardiologie, Toulouse, France. 8. CHU Montpellier, Service de Cardiologie, Montpellier, France. 9. CHU Brest, Service de Cardiologie, Brest, France. 10. CHU Angers, Service de Cardiologie, Angers, France. 11. l'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France; CHU Nantes, Service de Génétique Médicale, Nantes, France. 12. l'institut du thorax, INSERM, CNRS, UNIV Nantes, Nantes, France. 13. l'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France. Electronic address: jeanbaptiste.gourraud@chu-nantes.fr.
Abstract
BACKGROUND: Sodium-channel blocker challenge (SCBC) is frequently performed to unmask Brugada syndrome. OBJECTIVE: We aim to identify predictors of positivity and complications of SCBC in the setting of familial screening of Brugada syndrome. METHODS: All consecutive patients from 2000 to 2014 who benefit from a sodium-channel blocker and belong to a family with at least 2 subjects affected by the syndrome were enrolled and followed prospectively. Data were reviewed by 2 physicians blinded to the clinical and genetic status. RESULTS: Of the 672 SCBCs performed in 137 families, 337 (50%) were positive. Multivariate analysis identified ajmaline (odds ratio [OR] 2.98; 95% CI 1.65-4.91) and a significant S wave in lead DII (OR 3.11; 95% CI 2.12-4.58), DIII (OR 2.75; 95% CI 1.78-4.25), or V5 (OR 3.71; 95% CI 2.54-5.44) as predictors of a positive SCBC (P < .0001). Eleven patients (1.6%) presented complications (10 ventricular arrhythmias and 1 atrial flutter), but no deaths occurred. Familial history of complications (OR 41; lower quartile, upper quartile 10, 203; P < .0001), young age (P = .04), and decreased electrocardiographic conduction parameters at baseline (P = .04) were predictors of complications. QRS enlargement during SCBC was not associated with complications. During a median follow-up of 106 months (lower quartile, upper quartile 54, 143 months), 11 life-threatening arrhythmias occurred. CONCLUSION: SCBC in the screening of familial Brugada syndrome is safe. The risk of complication is considerably increased in the case of familial history of complicated SCBC, in young patients, and in the presence of decreased electrocardiographic conduction parameters. However, QRS enlargement during the test is not directly related to complications and should not be used to prematurely stop the test unless leading to false-negative results.
BACKGROUND: Sodium-channel blocker challenge (SCBC) is frequently performed to unmask Brugada syndrome. OBJECTIVE: We aim to identify predictors of positivity and complications of SCBC in the setting of familial screening of Brugada syndrome. METHODS: All consecutive patients from 2000 to 2014 who benefit from a sodium-channel blocker and belong to a family with at least 2 subjects affected by the syndrome were enrolled and followed prospectively. Data were reviewed by 2 physicians blinded to the clinical and genetic status. RESULTS: Of the 672 SCBCs performed in 137 families, 337 (50%) were positive. Multivariate analysis identified ajmaline (odds ratio [OR] 2.98; 95% CI 1.65-4.91) and a significant S wave in lead DII (OR 3.11; 95% CI 2.12-4.58), DIII (OR 2.75; 95% CI 1.78-4.25), or V5 (OR 3.71; 95% CI 2.54-5.44) as predictors of a positive SCBC (P < .0001). Eleven patients (1.6%) presented complications (10 ventricular arrhythmias and 1 atrial flutter), but no deaths occurred. Familial history of complications (OR 41; lower quartile, upper quartile 10, 203; P < .0001), young age (P = .04), and decreased electrocardiographic conduction parameters at baseline (P = .04) were predictors of complications. QRS enlargement during SCBC was not associated with complications. During a median follow-up of 106 months (lower quartile, upper quartile 54, 143 months), 11 life-threatening arrhythmias occurred. CONCLUSION: SCBC in the screening of familial Brugada syndrome is safe. The risk of complication is considerably increased in the case of familial history of complicated SCBC, in young patients, and in the presence of decreased electrocardiographic conduction parameters. However, QRS enlargement during the test is not directly related to complications and should not be used to prematurely stop the test unless leading to false-negative results.
Authors: Michelle M Monasky; Emanuele Micaglio; Giuseppe Ciconte; Sara Benedetti; Chiara Di Resta; Gabriele Vicedomini; Valeria Borrelli; Andrea Ghiroldi; Marco Piccoli; Luigi Anastasia; Vincenzo Santinelli; Maurizio Ferrari; Carlo Pappone Journal: Front Physiol Date: 2019-05-28 Impact factor: 4.566
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