Early repolarization pattern was associated with a higher rate of ventricular fibrillation episodes initiated by short-long-short sequence PVCs compared to Brugada syndrome (72.4% vs 15.1%, P<0.01).
Observational (n=19)
Does the mode of ventricular fibrillation initiation differ between patients with early repolarization pattern and Brugada syndrome?
Patients with early repolarization pattern and ventricular fibrillation have a distinct mode of VF initiation characterized by short-long-short sequences and shorter PVC coupling intervals compared to those with Brugada syndrome.
Absolute Event Rate: 72.4% vs 15.1%
p-value: p=< 0.01
AIMS: The aim of the present study was to identify specific electrocardiogram (ECG) features that predict the development of multiple episodes of ventricular fibrillation (VF) in patients with an early repolarization (ER) pattern and to compare the mode of VF initiation with that observed in typical cases of Brugada syndrome (BrS). METHODS AND RESULTS: The mode of the onset and the coupling intervals of the premature ventricular contractions (PVCs) initiating VF episodes were analysed in patients with BrS (n = 8) or ER who experienced sudden cardiac death/syncope or repeated appropriate implantable cardioverter defibrillator shocks. Among the 11 patients with ER, 5 presented with electrical storm (ES, four or more recurrent VF episodes/day). The five ES patients displayed a dramatic but very transient accentuation of J waves across the precordial and limb leads prior to the development of ES. Ventricular fibrillation episodes were more commonly initiated by PVCs with a short-long-short (SLS) sequence in ER (42/58, 72.4%) vs. BrS patients (13/86, 15.1%, P < 0.01). Coupling intervals were significantly shorter in the ER group compared with those with BrS 328 (320, 340) ms vs. 395 (350, 404) ms, P < 0.01. CONCLUSION: Our study provides additional evidence in support of the hypothesis that ER pattern in the ECG is not always benign. Transient augmentation of global J waves may be indicative of a highly arrhythmogenic substrate heralding multiple episodes of VF in patients with ER pattern. Ventricular tachycardia/VF initiation is more commonly associated with an SLS sequence, and PVCs display a shorter coupling interval in patients with ER pattern compared with those with BrS.
Nam et al. (木曜日) は、早期再分極パターンとブルガダ症候群における心室細動に関する観察研究を実施しました（n=19）。早期再分極パターンとブルガダ症候群は、PVCによって引き起こされる心室細動エピソードが短-長-短（SLS）配列で始まることを評価しました（p=< 0.01）。短-長-短配列のPVCによって始まる心室細動エピソードの発生率は、ブルガダ症候群と比較して、早期再分極パターンで高かった（72.4% 対 15.1%、P<0.01）。