Enhancement of J–ST‐Segment Elevation by the Glucose and Insulin Test in Brugada Syndrome

Abstract

The effects of glucose and insulin on J-ST-segment elevation were evaluated in seven men (mean age 45 +/- 10 years) with Brugada syndrome. Six patients had been reanimated from VF and one patient had experienced syncope. The effects of intavenous (1) pilsicainide 50 mg, (2) glucose 50 g, and (3) glucose 50 g plus regular insulin 10 IU on the precordial ECG leads were examined. Pilsicainide significantly enhanced J-ST elevation in all patients and induced VF in 1 patient. A significant accentuation of the abnormal J-ST configuration was observed in all patients at a mean of 51 +/- 40 minutes after glucose and insulin infusion. Changes in blood glucose and serum potassium concentration were 111 +/- 158 mg/dL and -0.30 +/- 0.48 mEq/L, respectively. These changes were not directly related to the ECG changes. Glucose infusion without insulin caused a subtle increase in J-ST elevation. In conclusion, the administration of glucose and insulin safely unmasked or accentuation the J-ST-segment elevation in Brugada syndrome. Blood glucose and insulin concentrations may be factors modulating the circadian or day-to-day ECG variations in this syndrome.

Brugada Syndrome and Carbohydrate Metabolism

“…They found the accentuation of ST-segment in high-risk Brugada syndrome patients. However, the changes of blood glucose (BG) in this study were not directly related to the ECG changes [17]. Another study by Nishizaki assessed oral glucose tolerance test (OGTT) in Brugada syndrome patients and control healthy subjects.…”

Sudden cardiac death secondary to antidepressant and antipsychotic drugs

“…ST segment elevation in BS is often dynamic. The Brugada ECG may often be concealed, but can be unmasked or modulated by sodium channel blockers, a febrile state, vagotonic agents, α-adrenergic agonists, β-adrenergic blockers, tricyclic or tetracyclic antidepressants, firstgeneration antihistaminics (dimenhydrinate), a combination of glucose and insulin, hyperkalemia, hypokalemia, hypercalcemia, and by alcohol and cocaine toxicity [37][38][39][40][41][42][43][44][45][46][47]. These agents may also induce acquired forms of BS.…”

Brugada Syndrome

“…A recent study by Nogami et al showed that glucose and insulin could unmask the Brugada ECG marker or accentuate the J-junction elevation of the ST-segment. 74 They observed a slight decrease in the serum potassium levels of their study patients, but it did not reach statistical significance. Nevertheless, these findings bode well for a heavy carbohydrate meal being a precipitating factor for sudden death in SUDS patients.…”