Key result
Drug-induced type 1 Brugada ECGs are associated with 87% inferolateral early repolarization prevalence versus spontaneous.
Why the study?
Spontaneous type 1 ECG predicts VF in Brugada syndrome, but is undetectable in some patients with VF, prompting investigation of differences between patients with spontaneous versus drug-induced type 1 ECG.
Are there clinical and electrocardiographic differences between Brugada syndrome patients with spontaneous versus drug-induced type 1 ECG who have experienced ventricular fibrillation?
Observational (n=44)
No
Are there clinical and electrocardiographic differences between Brugada syndrome patients with spontaneous versus drug-induced type 1 ECG who have experienced ventricular fibrillation?
Brugada syndrome patients with drug-induced type 1 ECG and prior VF frequently exhibit inferolateral early repolarization, contrasting with spontaneous type 1 ECG patients who more often show fragmented QRS and aVR signs.
May aid differentiation of Brugada subtypes post-VF; hypothesis-generating for refined phenotyping without changing practice.
BACKGROUND: Spontaneous type 1 electrocardiogram (ECG) in the right precordial lead is a dominant predictor of ventricular fibrillation (VF) in Brugada syndrome (BrS). In some BrS patients with VF, however, spontaneous type 1 ECG is undetectable, even in repeated ECG and immediately after VF. This study investigated differences between BrS patients with spontaneous or drug-induced type 1 ECG. METHODS AND RESULTS: We evaluated 15 BrS patients with drug-induced (D-BrS) and 29 with spontaneous type 1 ECG (SP-BrS). All patients had had a previous VF episode. In each D-BrS patient, ECG was recorded more than 15 times (mean, 46±34) during 7.2±5.1 years of follow-up. Age and family history were comparable between groups. Inferolateral early repolarization (ER) was observed in 13 D-BrS (87%) at least once but in only 3 SP-BrS (10%, P<0.01). Immediately after VF, inferolateral ER was accentuated in 9 of 10 D-BrS, while type 1 ECG was accentuated in 12 of 16 SP-BrS. Fragmented QRS in the right precordial lead and aVR sign were absent in D-BrS but present in 20 (69%, P<0.01) and 11 (38%, P<0.01) SP-BrS, respectively. There was no prognostic difference between groups. CONCLUSIONS: Although having similar clinical profiles, there are obvious ECG differences between VF-positive BrS patients with spontaneous or drug-induced type 1 ECG. The inferolateral lead rather than the right precordial lead on ECG may be particularly crucial in some BrS patients.
No takes yet. Share an insight, caveat, or question.
Nagayama et al. (2019) conducted an observational in Brugada syndrome with previous ventricular fibrillation (n=44). Drug-induced type 1 ECG vs. Spontaneous type 1 ECG was evaluated on Presence of inferolateral early repolarization (ER) (p=<0.01). Brugada syndrome patients with drug-induced type 1 ECG had a significantly higher prevalence of inferolateral early repolarization (87% vs 10%) compared to those with spontaneous type 1 ECG.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: