Prediction of ventricular arrhythmias in patients with a spontaneous Brugada type 1 pattern: the key is in the electrocardiogram

Abstract

Aims There is currently no reliable tool to quantify the risks of ventricular fibrillation or sudden cardiac arrest (VF/SCA) in patients with spontaneous Brugada type 1 pattern (BrT1). Previous studies showed that electrocardiographic (ECG) markers of depolarization or repolarization disorders might indicate elevated risk. We aimed to design a VF/SCA risk prediction model based on ECG analyses for adult patients with spontaneous BrT1. Methods and results This retrospective multicentre international study analysed ECG data from 115 patients (mean age 45.1 ± 12.8 years, 105 males) with spontaneous BrT1. Of these, 45 patients had experienced VF/SCA and 70 patients did not experience VF/SCA. Among 10 ECG markers, a univariate analysis showed significant associations between VF/SCA and maximum corrected Tpeak–Tend intervals ≥100 ms in precordial leads (LMaxTpec) (P < 0.001), BrT1 in a peripheral lead (pT1) (P = 0.004), early repolarization in inferolateral leads (ER) (P < 0.001), and QRS duration ≥120 ms in lead V2 (P = 0.002). The Cox multivariate analysis revealed four predictors of VF/SCA: the LMaxTpec [hazard ratio (HR) 8.3, 95% confidence interval (CI) 2.4–28.5; P < 0.001], LMaxTpec + ER (HR 14.9, 95% CI 4.2–53.1; P < 0.001), LMaxTpec + pT1 (HR 17.2, 95% CI 4.1–72; P < 0.001), and LMaxTpec + pT1 + ER (HR 23.5, 95% CI 6–93; P < 0.001). Our multidimensional penalized spline model predicted the 1-year risk of VF/SCA, based on age and these markers. Conclusion LMaxTpec and its association with pT1 and/or ER indicated elevated VF/SCA risk in adult patients with spontaneous BrT1. We successfully developed a simple risk prediction model based on age and these ECG markers.

Development and Validation of a Risk Prediction Model for Ventricular Arrhythmia in Elderly Patients with Coronary Heart Disease

“…Due to myocardial ischemia and partial myocardial tissue necrosis or fibrosis in patients with CHD, abnormal cardiac electrophysiological remodeling occurs, which is easy to induce VA. ECG indexes can reflect the electrophysiological changes of the heart. Although there were some studies that incorporate ECG indexes into the prediction model of clinical events [6][7][8][9][10], there was still a lack of large sample research on the combination of multiple ECG parameters for VA in elderly patients with CHD. Previous researches paid more attention to the relationship of one single ECG index and VA [11,12], while myocardial electrical activity is actually influenced by multifactors.…”

Outcomes in Brugada Syndrome Patients With Implantable Cardioverter-Defibrillators: Insights From the SGLT2 Registry

“…For example, the predictive value of ventricular tachyarrhythmia inducibility in EPS remains debated when results were examined in large registries, with significantly greater event rates for inducible arrhythmias when compared to spontaneously occurring VT/VF or SCD (Brugada et al, 2002;Priori et al, 2012). Electrocardiographic indices may be of predictive value but are limited by the dynamic nature of conduction or repolarization abnormalities (Tse et al, 2017;Deliniere et al, 2019). Although BrS is found to be associated with genetic mutations, notably in the SCN5A gene, the low prevalence of genetic testing (∼25%) and heterogeneity in patients' genetic profile restricts its application in risk stratification (Milman et al, 2018;.…”

Does the Age of Sudden Cardiac Death in Family Members Matter in Brugada Syndrome?

“…A total of 22 (20 cohorts and 2 case‐control) studies from 27 countries (95 studied centers) involving 3386 patients with BrS during the study period of 2004–2019 were included in our meta‐analysis. 2 , 8 , 31 The ages of cut point of SCD among family members in different studies were >45 years old, 12 <50 years old, 13 <45 years old, 8 , 14 , 15 , 16 , 17 , 20 , 21 , 24 , 29 <40 years old, 19 , 22 and <35 years old. 29 a Nine studies did not report age of cut point of SCD among family members.…”

“…Positive family history was defined as at least 1 first‐ or second‐degree relative who had sudden unexplained death, sudden cardiac death (SCD), or sudden cardiac arrest or as defined in each study ( Table ). 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 …”