Idiopathic Ventricular Fibrillation Induced With Vagal Activity in Patients Without Obvious Heart Disease

Kasanuki, Hiroshi; Ohnishi, Satoshi; Ohtuka, Masato; Matsuda, Naoki; Nishizaki, Takashi; Isogai, Reiko; Shoda, Morio; Toyoshima, Yukari; Hosoda, Saichi

doi:10.1161/01.cir.95.9.2277

Cited by 369 publications

(309 citation statements)

References 15 publications

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“…A circadian variation of fluctuation in ST elevation was also demonstrated 8,11 and ST elevation always became prominent just before VF episodes. 8 We recently reported a dynamic, circadian change in ST elevation during daily life of BS patients by means of a unipolar lead Holter ECG. 11 In that study, an increase in vagal activity occurred together with a spontaneous augmentation of ST elevation.…”

Section: Circulation Journal Vol70 July 2006mentioning

confidence: 79%

“…[7][8][9]13,14 Several studies have demonstrated that the ECG in patients with BS changes dynamically. 8,9,11,13 The configuration and degree of ST-segment elevation in the precordial leads change from day to day. A circadian variation of fluctuation in ST elevation was also demonstrated 8,11 and ST elevation always became prominent just before VF episodes.…”

Section: Circulation Journal Vol70 July 2006mentioning

confidence: 99%

“…8,9,11,13 The configuration and degree of ST-segment elevation in the precordial leads change from day to day. A circadian variation of fluctuation in ST elevation was also demonstrated 8,11 and ST elevation always became prominent just before VF episodes. 8 We recently reported a dynamic, circadian change in ST elevation during daily life of BS patients by means of a unipolar lead Holter ECG.…”

Section: Circulation Journal Vol70 July 2006mentioning

confidence: 99%

“…2,4,[17][18][19] In contrast, evidence of a depolarization abnormality, especially delayed conduction in the right ventricle, has been presented. 8,[17][18][19] Depolarization abnormality is reflected in prolonged HV intervals, abnormal late potential and abnormal delayed potential in the epicardial region of the right ventricular outflow tract. 8,16,[20][21][22] A widening of the S wave in the right precordial leads, reflecting an underlying right ventricular conduction delay, was frequently observed in symptomatic patients and might be an important indicator of increased risk.…”

Section: Rate-dependent Changes In S Wave and Qrs Durationmentioning

confidence: 99%

“…5,6 The typical ECG changes are variable over time and are modulated by exercise or pharmacological interventions that interact with autonomic nervous activities. 5,[7][8][9] We recently reported an inadequate prolongation of the QT interval (short QT interval) at longer RR intervals 10 and an augmentation of the ST elevation through vagal activity in patients with BS. 11 The nighttime onset of VF episodes may be related to both a shorter QT interval and an enhanced ST elevation during bradycardia at night.…”

mentioning

confidence: 99%

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Bradycardia-Dependent ECG Changes in Brugada Syndrome

Mizumaki

Fujiki

Nishida

et al. 2006

Circ J

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rugada syndrome (BS), a distinct subtype of idiopathic ventricular fibrillation (VF), is characterized by a distinctive ST segment elevation in the right precordial leads. [1][2][3] The mechanism responsible for this ST segment elevation and genesis of VF is still under investigation. Several possible mechanisms have been proposed for the ST segment elevation in BS. Among them are conduction delay, accentuation of the action potential notch and loss of the action potential dome in the right ventricular outflow epicardium. 3,4 In BS, unlike other diseases, VF and sudden death mainly occur in the resting state, predominantly during sleep. 5,6 The typical ECG changes are variable over time and are modulated by exercise or pharmacological interventions that interact with autonomic nervous activities. 5,[7][8][9] We recently reported an inadequate prolongation of the QT interval (short QT interval) at longer RR intervals 10 and an augmentation of the ST elevation through vagal activity in patients with BS. 11 The nighttime onset of VF episodes may be related to both a shorter QT interval and an enhanced ST elevation during bradycardia at night. This could be because of a slow recovery from the inactivation of prominent Ito. 12 However, it is still unclear how the RR intervals affect the ECG changes in BS and whether rate dependent changes in the ECG would be different between symptomatic and asymptomatic patients. The present study was therefore designed to examine the effects of the RR intervals on ECG changes during an electrophysiologic study (EPS) in both symptomatic and asymptomatic patients. Methods Study PopulationTwenty-one consecutive male patients with BS were studied: 9 were symptomatic with either documented VF or episodes of unexplained syncope, and the other 12 were asymptomatic without either spontaneous VF or inducible VF during the EPS. The study protocol was approved by the institutional review board and written informed consent was given by all patients before participation. We diagnosed BS in accordance with recently established ECG criteria. 3 Patients with coved-type ST elevation accompanied by Jwave amplitude ≥2 mm in one of the leads V1-3 were included. 3 For patients with saddle-back-type ST elevation (type 2 or 3), coved-type ST elevation ≥2 mm induced by pilsicainide, a class Ic antiarrhythmic drug, was required. 3 In all patients, physical examination, chest X-ray, 2-dimensional-echocardiography, exercise test and thallium or 99m Tc-tetrofosmin myocardial single photon emission computed tomography failed to disclose apparent evidence of organic heart disease. Patients with diabetes mellitus, long QT syndrome or electrolyte abnormality and patients taking any drugs were excluded from the present study. EPS and Analysis of ECGsEPS was performed in all 21 patients after all antiarrhythmic drugs had been discontinued for at least 5 halflives of the drug. A steerable 6F octapolar catheter with Background In patients with Brugada syndrome (BS), ventricular fibrillation (VF) occurs mainly during ...

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