Key result
Day-to-day early repolarization variation predicts ~248% higher VTA risk in Brugada syndrome.
Why the study?
The clinical implications of day-to-day variation of the early repolarization pattern on ventricular tachyarrhythmia events in Brugada syndrome patients were unclear.
Does day-to-day variation of the early repolarization pattern predict ventricular tachyarrhythmia events in patients with Brugada syndrome?
Cohort (n=41)
Does day-to-day variation of the early repolarization pattern predict ventricular tachyarrhythmia events in patients with Brugada syndrome?
Day-to-day variation of the early repolarization pattern is an independent predictor of life-threatening ventricular tachyarrhythmias in patients with Brugada syndrome.
Day-to-day ER variation may aid VTA risk stratification in Brugada syndrome; hypothesis-generating and requires prospective validation.
BACKGROUND: We assessed the relationship between day-to-day variation of the early repolarization (ER) pattern and ventricular tachyarrhythmia (VTA) events in Brugada syndrome (BrS) patients because the clinical implications are unclear. METHODS AND RESULTS: This retrospective study consisted of 41 patients with BrS who underwent implantable cardioverter-defibrillator (ICD) implantation. BrS was diagnosed by a spontaneous or drug-induced type 1 ECG without structural heart disease. Day-to-day variation of the ER pattern was defined as temporal change in the J-point (≥0.1 mV) on ECG. VTA events were detected via ICD interrogation: 15 patients experienced VTA events during 124±62 months' observation. Day-to-day variation of the ER pattern was positive in 7 patients (17%). In the multivariate Cox proportional hazards model, day-to-day variation of a positive ER pattern (hazard ratio [HR]: 3.475, 95% confidence interval [CI]: 1.105-10.414, P=0.034) and documented history of VTA (HR: 4.802, 95% CI: 1.547-17.995, P=0.006) were independent predictors of VTA events. In patients with electrical storm (ES: n=9), day-to-day variation of the ER pattern was positive in 5 patients (56%). ES events were more frequently observed in patients with a positive day-to-day variation of ER pattern than in those without (P<0.05). CONCLUSIONS: The incidence of day-to-day variation of the ER pattern was higher in patients with arrhythmic events of VTA and/or ES among BrS patients with ICD.
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Ishizue et al. (2020) conducted a cohort in Brugada syndrome (n=41). Day-to-day variation of early repolarization pattern vs. No day-to-day variation of early repolarization pattern was evaluated on Ventricular tachyarrhythmia (VTA) events (HR 3.475, 95% CI 1.105-10.414, p=0.034). Day-to-day variation of the early repolarization pattern independently predicted ventricular tachyarrhythmia events in patients with Brugada syndrome (HR 3.475; 95% CI 1.105-10.414; P=0.034).
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