Jesus Castro Hevia1, Margarita Dorantes Sanchez2, Frank Martinez Lopez3, Osmin Castañeda Chirino4, Roylan Falcon Rodriguez5, Marcelo Puga Bravo6, Joanna de Zayas Galguera7, Charles Antzelevitch8. 1. Arrhythmia Unit, Cardiovascular Surgery and Cardiology Institute, Havana, Cuba. Electronic address: jcastroh@infomed.sld.cu. 2. Arrhythmia Unit, Cardiovascular Surgery and Cardiology Institute, Havana, Cuba. Electronic address: dorantes@infomed.sld.cu. 3. Arrhythmia Unit, Cardiovascular Surgery and Cardiology Institute, Havana, Cuba. Electronic address: fmatinez@infomed.sld.cu. 4. Arrhythmia Unit, Cardiovascular Surgery and Cardiology Institute, Havana, Cuba. Electronic address: osmincastaneda@infomed.sld.cu. 5. Arrhythmia Unit, Cardiovascular Surgery and Cardiology Institute, Havana, Cuba. Electronic address: annia@infomed.sld.cu. 6. Arrhythmia Unit, Cardiovascular Surgery and Cardiology Institute, Havana, Cuba. 7. Arrhythmia Unit, Cardiovascular Surgery and Cardiology Institute, Havana, Cuba. Electronic address: joannadezayas@infomed.sld.cu. 8. Lankenau Institute for Medical Research, Wynnewood, PA, United States of America; Lankenau Heart Institute, Main Line Health System, Wynnewood, PA, United States of America; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States of America. Electronic address: cantzelevitch@gmail.com.
Abstract
BACKGROUND: A spontaneous coved-type ST segment elevation in the electrocardiogram (ECG) has long been recognized as a risk stratification tool in patients with Brugada syndrome (BrS). This Type-I ST segment elevation is known to exhibit high dynamicity, fluctuating between coved-type and non-coved ST segment elevation. Our objectives in this study were to: 1) Compare ECG parameters in patients with spontaneous coved-type (Type-I) vs. non-coved-type ST segment ECGs; 2) Determine the variability of these ECG parameters with repeated measurements; and 3) Assess the predictive value of ECG parameters in these two groups during follow-up. METHODS: Forty-two consecutive patients with BrS and implanted ICD were studied between 2000 and 2017. Serial ECGs and clinical characteristics were obtained over a period of 199 months. RESULTS: QT-interval, QTc-interval, QRS duration, Tp-e interval and Tp-e dispersion were all significantly longer in spontaneous Type I vs. non-Type 1 ECGs and all ECG parameters displayed significant variability during serial recording obtained throughout the follow-up period. Patients with a spontaneous Type I ECG during the 114 ± 56 months follow-up period were at a much higher risk for VT/VF than those without a Type I ECG (p = 0.016). Moreover, the risk for development of life-threatening ventricular arrhythmias was directly related to the fraction of ECGs displaying a spontaneous Type I pattern during follow-up. CONCLUSION: Our study illustrates the need for multiple ECGs to aid with both the diagnosis and prognosis of BrS. Serial ECGs can assist with risk stratification based on the fraction of ECGs that display a spontaneous Type-I BrS ECG.
BACKGROUND: A spontaneous coved-type ST segment elevation in the electrocardiogram (ECG) has long been recognized as a risk stratification tool in patients with Brugada syndrome (BrS). This Type-I ST segment elevation is known to exhibit high dynamicity, fluctuating between coved-type and non-coved ST segment elevation. Our objectives in this study were to: 1) Compare ECG parameters in patients with spontaneous coved-type (Type-I) vs. non-coved-type ST segment ECGs; 2) Determine the variability of these ECG parameters with repeated measurements; and 3) Assess the predictive value of ECG parameters in these two groups during follow-up. METHODS: Forty-two consecutive patients with BrS and implanted ICD were studied between 2000 and 2017. Serial ECGs and clinical characteristics were obtained over a period of 199 months. RESULTS: QT-interval, QTc-interval, QRS duration, Tp-e interval and Tp-e dispersion were all significantly longer in spontaneous Type I vs. non-Type 1 ECGs and all ECG parameters displayed significant variability during serial recording obtained throughout the follow-up period. Patients with a spontaneous Type I ECG during the 114 ± 56 months follow-up period were at a much higher risk for VT/VF than those without a Type I ECG (p = 0.016). Moreover, the risk for development of life-threatening ventricular arrhythmias was directly related to the fraction of ECGs displaying a spontaneous Type I pattern during follow-up. CONCLUSION: Our study illustrates the need for multiple ECGs to aid with both the diagnosis and prognosis of BrS. Serial ECGs can assist with risk stratification based on the fraction of ECGs that display a spontaneous Type-I BrS ECG.
Authors: Arthur A M Wilde; Charles Antzelevitch; Martin Borggrefe; Josep Brugada; Ramón Brugada; Pedro Brugada; Domenico Corrado; Richard N W Hauer; Robert S Kass; Koonlawee Nademanee; Silvia G Priori; Jeffrey A Towbin Journal: Circulation Date: 2002-11-05 Impact factor: 29.690
Authors: Jesus Castro Hevia; Charles Antzelevitch; Francisco Tornés Bárzaga; Margarita Dorantes Sánchez; Francisco Dorticós Balea; Roberto Zayas Molina; Miguel A Quiñones Pérez; Yanela Fayad Rodríguez Journal: J Am Coll Cardiol Date: 2006-04-17 Impact factor: 24.094
Authors: Charles Antzelevitch; Pedro Brugada; Martin Borggrefe; Josep Brugada; Ramon Brugada; Domenico Corrado; Ihor Gussak; Herve LeMarec; Koonlawee Nademanee; Andres Ricardo Perez Riera; Wataru Shimizu; Eric Schulze-Bahr; Hanno Tan; Arthur Wilde Journal: Circulation Date: 2005-01-17 Impact factor: 29.690
Authors: M Juhani Junttila; Pedro Brugada; Kui Hong; Eric Lizotte; Marc DE Zutter; Andrea Sarkozy; Josep Brugada; Begona Benito; Juha S Perkiomaki; Timo H Mäkikallio; Heikki V Huikuri; Ramon Brugada Journal: J Cardiovasc Electrophysiol Date: 2007-12-12
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