Prognostic significance of early repolarization in inferolateral leads in Brugada patients with documented ventricular fibrillation: A novel risk factor for Brugada syndrome with ventricular fibrillation

Kawata, Hiro; Morita, Hiroshi; Yamada, Yuko; Noda, Takashi; Sato, Kazuhiro; Aiba, Takeshi; Isobe, Mitsuaki; Nagase, Satoshi; Nakamura, Kazufumi; Kusano, Kengo; Ito, Hiroshi; Kamakura, Shiro; Shimizu, Wataru

doi:10.1016/j.hrthm.2013.04.009

Cited by 118 publications

(86 citation statements)

References 42 publications

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“…11 Moreover, ERP was observed by Kawata et al in 63% of patients with BrS and documented VF and a worse outcome was observed in these patients when ERP was persistent. 10 To date, there are no validated techniques to provoke ERP, although 12-lead Holter monitoring might be useful to detect evidence of ERP during bradycardia. 22 Preliminary results have suggested a diagnostic value of the Valsalva maneuver in identifying concealed ERP cases among family members of ERP syndrome patients.…”

Section: Study Limitationsmentioning

confidence: 99%

Prevalence and Clinical Impact of Early Repolarization Pattern and QRS-Fragmentation in High-Risk Patients With Brugada Syndrome

Conte

Asmundis

Sieira

et al. 2016

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp leads has been identified as an arrhythmic marker and might indicate regional conduction disturbance in the right ventricular outflow tract (RVOT) of patients with BrS. 12 Although the presence of repolarization and depolarization abnormalities in patients with BrS has been previously assessed, in those studies only a small portion of patients were implanted with an ICD. 7,13 Conversely, f-QRS and ERP have not been systematically investigated in high-risk patients. Moreover, a previous study on BrS patients undergoing ICD therapy showed that spontaneous type 1 ECG was not an independent predictor for further arrhythmic events. 5 In addition, nearly 13% of asymptomatic patients with an ICD presented an appropriate shock during follow-up. 5 Whether the preliminary results coming from previous studies suggest that these abnormalities could have a prognostic role in BrS, no data are available on the contributing role of ERP, f-QRS or combined ERP/f-QRS rugada syndrome (BrS) is an inheritable syndrome characterized by an increased risk of sudden death (SD) in the absence of structural heart disease. 1,2 The placement of an implantable cardioverter-defibrillator (ICD) remains the only therapy with proven efficacy to prevent SD in patients with BrS at high risk for further arrhythmic events. 3-5 Although the presence of spontaneous or drug-induced coved-type STsegment elevation in the right precordial leads (V1-3) is the ECG hallmark of the syndrome, some patients show additional early repolarization signs in the inferolateral leads, or present with depolarization abnormalities. 3,6-9 Early repolarization pattern (ERP) is a recognized risk factor for ventricular arrhythmias (VAs) in patients with BrS and may appear, on 12-lead ECG, as notching of the terminal portion of the QRS complex in the inferior and/or lateral leads. 10,11 Similarly, abnormal fragmentation of the QRS complex (f-QRS) in the right precordial Background: The phenotypic heterogeneity of Brugada syndrome (BrS) can lead some patients to show an additional inferolateral early repolarization pattern (ERP), or fragmented QRS (f-QRS). The aim of the study was to investigate the prevalence and clinical impact of f-QRS, ERP or combined f-QRS/ERP in high-risk patients with BrS.

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Section: Study Limitationsmentioning

confidence: 99%

Prevalence and Clinical Impact of Early Repolarization Pattern and QRS-Fragmentation in High-Risk Patients With Brugada Syndrome

Conte

Asmundis

Sieira

et al. 2016

Circ J

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“…BrS was diagnosed according to the following currently accepted criteria 2,6,[11][12][13][14] : (1 Original Article…”

Section: Study Populationmentioning

confidence: 99%

“…[8][9][10] The presence of J waves in patients presenting with BrS may also be a predictor of poor prognosis. 6,[11][12][13] The purpose of this multicenter study was to evaluate the characteristics of patients with BrS and ES, with a special attention to the presence of J waves. …”

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Electrical Storm in Patients With Brugada Syndrome Is Associated With Early Repolarization

Kaneko

Horie

Niwano

et al. 2014

Circ: Arrhythmia and Electrophysiology

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We recently observed a case of BrS characterized by prominent J waves in the inferolateral leads of the 12-lead ECG and electrical storms (ESs). 7 Case-control studies have described a close association between J waves, a sign of early repolarization (ER), and idiopathic VF. [8][9][10] The presence of J waves in patients presenting with BrS may also be a predictor of poor prognosis. 6,[11][12][13] The purpose of this multicenter study was to evaluate the characteristics of patients with BrS and ES, with a special attention to the presence of J waves. Methods Study PopulationWe retrospectively identified 22 men at 8 Japanese medical institutions, who presented with BrS and ES, defined as ≥3 episodes of VF/d. BrS was diagnosed according to the following currently accepted criteria 2,6,[11][12][13][14] : (1 Original ArticleBackground-Electrical storms (ESs) in patients with Brugada syndrome (BrS) are rare though potentially lethal. Methods and Results-We studied 22 men with BrS and ES, defined as ≥3 episodes/d of ventricular fibrillation (VF) and compared their characteristics with those of 110 age-matched, control men with BrS without ES. BrS was diagnosed by a spontaneous or drug-induced type 1 pattern on the ECG in the absence of structural heart disease. Early repolarization (ER) was diagnosed by J waves, ie, >0.1 mV notches or slurs of the terminal portion of the QRS complex. The BrS ECG pattern was provoked with pilsicainide. A spontaneous type I ECG pattern, J waves, and horizontal/descending ST elevation were found, respectively, in 77%, 36%, and 88% of patients with ES, versus 28% (P<0.0001), 9% (P=0.003), and 60% (P=0.06) of controls. The J-wave amplitude was significantly higher in patients with than without ES (P=0.03). VF occurred during undisturbed sinus rhythm in 14 of 19 patients (74%), and ES were controlled by isoproterenol administration. All patients with ES received an implantable cardioverter defibrillator and over a 6.0±5.4 years followup, the prognosis of patients with ES was significantly worse than that of patients without ES. Bepridil was effective in preventing VF in 6 patients. Conclusions-A high prevalence of ER was found in a subgroup of patients with BrS associated with ES. ES appeared to be suppressed by isoproterenol or quinidine, whereas bepridil and quinidine were effective in the long-term prevention of VF in the highest-risk patients. (Circ Arrhythm Electrophysiol. 2014;7:1122-1128.)

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“…23 Moreover, Kawata et al reported ER pattern in up to 63 % of patients with BrS and documented VF and a worse outcome when ER pattern was persistent. 24 It is worth noting that previous studies on ER syndrome have potentially included patients with BrS and nondiagnostic baseline ECG. A very recent study has, in fact, shown that up to 30 % with an initial diagnosis of ER syndrome display spontaneous Brugada type 1 in the high intercostal right precordial leads only, and most VF recurrences occur in patients with ER pattern and Brugada type 1 ECG documented in any of the right precordial leads.…”

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confidence: 99%

Brugada Syndrome and Early Repolarisation: Distinct Clinical Entities or Different Phenotypes of the Same Genetic Disease?

Conte

Caputo

Regoli

et al. 2016

Arrhythmia &Amp; Electrophysiology Review

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General understanding of early repolarisation (ER) has dramatically changed in the last decade. For several years, ER has been considered a benign electrocardiographic (ECG) finding with high prevalence in the general population. Recently different studies have challenged this view and showed a significant association with life-threatening arrhythmias. [1][2][3][4][5] In 2008 Haïssaguerre et al. first reported an increased prevalence of a particular pattern of ER on the resting 12-lead ECG of patients with history of idiopathic ventricular fibrillation (VF) (see Figure 1). 2 In these patients, ER was characterised by elevation of the QRS-ST segment junction of at least 0.1 mV above the baseline level, manifesting as QRS slurring (a smooth transition from the QRS complex to the ST segment) or notching (a positive J deflection of at least 1 mm inscribed on the S wave) in two adjacent inferior (II, III and aVF), lateral (I, aVL, and V4-V6), or infero-lateral leads. The ER pattern was observed in 31 % of patients with idiopathic VF and in 5 % of healthy control subjects.Moreover, patients with idiopathic VF and ER pattern presented a higher risk of experiencing an arrhythmic recurrence during a 5-year follow-up.2 This observation was confirmed by a case-control study showing that J-point elevation in the inferior and lateral leads is more frequent in patients with idiopathic VF than in matched control subjects (27 % versus 8 % in inferior leads; 13 % versus 1 % in lateral leads).3 Conversely, ER localised exclusively in V4 to V6 occurs with similar frequency among patients and healthy subjects.

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Prognostic significance of early repolarization in inferolateral leads in Brugada patients with documented ventricular fibrillation: A novel risk factor for Brugada syndrome with ventricular fibrillation

Cited by 118 publications

References 42 publications

Prevalence and Clinical Impact of Early Repolarization Pattern and QRS-Fragmentation in High-Risk Patients With Brugada Syndrome

Prevalence and Clinical Impact of Early Repolarization Pattern and QRS-Fragmentation in High-Risk Patients With Brugada Syndrome

Electrical Storm in Patients With Brugada Syndrome Is Associated With Early Repolarization

Brugada Syndrome and Early Repolarisation: Distinct Clinical Entities or Different Phenotypes of the Same Genetic Disease?

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