Key result
Combined analysis of night-time late potentials and peak T-wave amplitude variability on ambulatory ECG discriminated Brugada syndrome patients with a history of ventricular fibrillation or asystole from healthy controls with a 93% discriminant ratio.
Why the study?
Does combined analysis of late potentials and T-wave amplitude variability on ambulatory ECG improve identification of high-risk patients with Brugada syndrome?
Observational (n=152)
Single-blind (cardiologists blinded to clinical status)
No
Does combined analysis of late potentials and T-wave amplitude variability on ambulatory ECG improve identification of high-risk patients with Brugada syndrome?
Combined analysis of late potentials and T-wave amplitude variability on ambulatory ECG, accounting for circadian periodicity, improves the identification of high-risk Brugada syndrome patients.
Answers are grounded in this paper and cite their sources.
May support ambulatory ECG for Brugada risk stratification; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: Risk stratification is important in the management of Brugada syndrome (BrS). Late potentials (LPs) and T-wave amplitude variability (TAV) in high-resolution ambulatory electrocardiography (ECG) were retrospectively investigated. METHODS AND RESULTS: One hundred and twenty-seven patients diagnosed with BrS on 12-lead ECG were classified into 3 groups: documented ventricular fibrillation (VF)/asystole (n=19), episodes of syncope alone (n=30), and asymptomatic (n=78). Healthy volunteers were enrolled as controls (n=25). In the BrS patients, LPs showed appreciable circadian periodicity; filtered QRS duration (fQRS) and duration of the terminal low-amplitude signal <40 μV (LAS40) increased, whereas root mean square voltage of the terminal 40 ms of the fQRS (RMS40) decreased at night compared with the day. TAV did not have such a circadian periodicity. LP-positive incidence (night-time) and peak TAV were as follows: VF/asystole>syncope/asymptomatic>control (P<0.001). VF/asystole was discriminated from control at a ratio of 81-84% by night-time LPs (fQRS >116 ms, LAS40 >35 ms, RMS40 <25 μV) or peak TAV (>54 μV); VF/asystole was discriminated from syncope/asymptomatic at a ratio of 60-69%, by night-time LPs (fQRS >122 ms, LAS40 >42 ms, RMS40 <18μV) or peak TAV (>58 μV). Combined analysis of LPs and peak TAV increased the discriminant ratio up to 93% and 77%, respectively. CONCLUSIONS: Analysis of both LPs and TAV (taking circadian periodicity into account) is useful in identification of high-risk BrS patients.
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Yoshioka et al. (2012) conducted an observational in Brugada syndrome (n=152). Combined analysis of night-time late potentials and peak T-wave amplitude variability vs. Control subjects and lower-risk Brugada syndrome patients was evaluated on Discrimination of ventricular fibrillation/asystole from control subjects (Discriminant ratio 93%). Combined analysis of night-time late potentials and peak T-wave amplitude variability on ambulatory ECG discriminated Brugada syndrome patients with a history of ventricular fibrillation or asystole from healthy controls with a 93% discriminant ratio.
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