Key result
Early repolarization and Brugada syndromes were associated with a significantly smaller 24-hour QT/RR slope compared to controls (0.103 and 0.106 vs 0.156, P<0.001), particularly at night.
Why the study?
Do patients with early repolarization syndrome and Brugada syndrome exhibit impaired nocturnal QT-rate dependence compared to controls?
Observational (n=172)
Do patients with early repolarization syndrome and Brugada syndrome exhibit impaired nocturnal QT-rate dependence compared to controls?
Patients with early repolarization and Brugada syndromes exhibit attenuated QT-rate dependence and impaired QT day-night modulation, particularly during midnight and early morning, which may explain their propensity for nocturnal sudden cardiac death.
May link blunted QT adaptation to nocturnal SCD risk in these syndromes; hypothesis-generating for prospective risk-stratification studies.
INTRODUCTION: We reported impaired QT-rate dependence in early repolarization syndrome (ERS); however, contemporary data have shown peak incidence of sudden cardiac death (SCD) in ERS and Brugada syndrome (BrS) at mid-night and early morning. Taken together, we analyzed the nocturnal QT-rate dependence in both syndromes. METHODS AND RESULTS: A total of 172 subjects were enrolled: 11 ERS, 11 BrS patients, 50 subjects with an uneventful ER pattern (ERP), and 100 non-J-wave control subjects. Ambulatory ECG-derived parameters (QT, QTc, and QT/RR slope) and day-night QT difference were analyzed and compared. Among the groups, there was no significant difference in the average QT or QTc; however, the 24-hour QT/RR slope was significantly smaller in ERS and BrS patients (0.103 ± 0.01 and 0.106 ± 0.01, respectively) than in the control group (0.156 ± 0.03, P < 0.001). Detailed analysis showed a lower day-night QT difference in ERS and BrS patients (19 ±18.7 and 24 ±14 milliseconds, respectively) than in the controls (40 ± 22 milliseconds, P = 0.007) with the lowest QT/RR slopes seen in the ERS and BrS groups from 0 to 3:00 am (QT/RR; 0.076 ± 0.02 vs. 0.092 ± 0.04 vs. 0.117 ± 0.04, for the ERS, BrS, and controls, respectively, P = 0.004) and from 3 to 6 am (QT/RR 0.074 ± 0.03 vs. 0.079 ± 0.02 vs. 0.118 ± 0.04, P < 0.001). CONCLUSION: In a large population of age- and gender-matched groups, both ERS and BrS patients showed attenuated QT-rate dependence and impaired QT day-night modulation that may provide a baseline reentrant substrate. Importantly, QT/RR maladaptation was most evident at mid-night and early morning, which may explain the propensity of such patients to develop SCD during this critical period.
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Talib et al. (2014) conducted an observational in Early repolarization syndrome and Brugada syndrome (n=172). Early repolarization syndrome and Brugada syndrome vs. Non-J-wave control subjects was evaluated on 24-hour QT/RR slope (p=<0.001). Early repolarization and Brugada syndromes were associated with a significantly smaller 24-hour QT/RR slope compared to controls (0.103 and 0.106 vs 0.156, P<0.001), particularly at night.
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