Comparison of circadian, weekly, and seasonal variations of electrical storms and single events of ventricular fibrillation in patients with Brugada syndrome

Q: What are the key findings of this study?

Electrical storms in Brugada syndrome occurred more frequently on weekends than single VF events (47.4% vs 12.3%, P=0.035) and peaked in winter/spring (66.7%, P=0.012).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Brugada syndrome with ventricular fibrillation or electrical storm (n=44). Intervention: Electrical storm (≥3 separate episodes of VF/24 h) vs. Single episode of ventricular fibrillation. Primary outcome: Weekend occurrence (Saturday and Sunday) of ventricular fibrillation episodes (p=0.035).

Q: What does this research mean for the field?

Electrical storms in patients with Brugada syndrome occur significantly more often on weekends and peak during winter and spring compared with single ventricular fibrillation events. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Yoshiyasu Aizawa; Yoshiyasu Aizawa; Seiji Takatsuki; Yoshiaki Kaneko; Takashi Noda; Yoshinori Katsumata; Takahiko Nishiyama; Takehiro Kimura; Nobuhiro Nishiyama; Kotaro Fukumoto; Shinichi Niwano; Takashi Kurita; Takeshi Mitsuhashi; Shiro Kamakura; Akihiko Shimizu; Minoru Horie; Yoshifusa Aizawa; Yoshifusa Aizawa; Keiichi Fukuda

doi:10.1016/j.ijcha.2016.05.008

Key result

Brugada electrical storms occur ~4-fold more often on weekends than single VF episodes.

P=0.035
n=44

Why the study?

This study compared the circadian, weekly, and seasonal variations of electrical storms and single events of ventricular fibrillation in patients with Brugada syndrome.

Does the circadian, weekly, and seasonal distribution of ventricular fibrillation differ between patients with electrical storms versus single ventricular fibrillation events in Brugada syndrome?

Key Points

To compare the circadian, weekly, and seasonal distribution patterns of electrical storms versus isolated ventricular fibrillation episodes in patients with Brugada syndrome.
Analyzed 44 patients with Brugada syndrome who experienced ventricular fibrillation, stratified into those with electrical storms (n = 23) and those with single episodes (n = 21).
Evaluated clinical and electrocardiographic parameters alongside the exact timing of arrhythmic events across hours, days of the week, and seasons over a mean follow-up of 6.2 ± 4.9 years.
Patients with electrical storms were significantly younger than those with single events (38 ± 13 vs. 48 ± 16 years, P = 0.004), while both groups experienced arrhythmias primarily at night between 20:00 and 8:00 (75.0% vs. 76.5%).
Electrical storms peaked on Saturday (P < 0.001 vs. other weekdays) and occurred more frequently on weekends compared to single events (47.4% vs. 12.3%, P = 0.035), whereas single episodes peaked on Monday (P = 0.097).
Electrical storm incidence was significantly higher during winter and spring compared to other seasons (66.7% vs. 33.3%, P = 0.012), whereas single ventricular fibrillation episodes showed no seasonal variation (46.7% vs. 53.3%, P = 0.835).

Study Design

Type

Cohort (n=44)

Multicenter

Yes

Structured PICO

Does the circadian, weekly, and seasonal distribution of ventricular fibrillation differ between patients with electrical storms versus single ventricular fibrillation events in Brugada syndrome?

P

Population

44 patients with Brugada syndrome and at least one episode of ventricular fibrillation (mean age 42 years, 95.3% male), free of structural heart disease, followed for 6.2 ± 4.9 years.

E

Exposure

Electrical storm group (n=23; defined as ≥3 separate episodes of VF per 24 hours; managed acutely with IV isoproterenol and chronically with ICD and optional antiarrhythmic drugs such as bepridil or quinidine)

C

Comparator

Single ventricular fibrillation event group (n=21; patients with Brugada syndrome experiencing only a single VF episode; managed with ICD and optional antiarrhythmic drugs)

O

Outcome

Circadian, weekly, and seasonal rhythmicity/distribution patterns of ventricular fibrillation and electrical storm onset (obtained from medical charts or ICD records)hard clinical

Main Result

Absolute Event Rate: 47.4% vs 12.3%

p-value: p=0.035

In Brugada syndrome, both electrical storms and single VF episodes occur predominantly at night, but electrical storms uniquely peak on Saturdays and during winter and spring, suggesting that patients admitted with VF during these periods warrant closer intensive care monitoring for electrical storm development.

Limitations

Relatively small sample size requiring confirmation in a larger number of patients
Unable to confirm specific precipitating factors involved in the development of electrical storms
Role of vagal tone in specific weekdays or seasons in producing rhythmicity of VF was not evident
ECG findings were not analyzed in a serial manner
Genetic studies were not performed to evaluate responsible genes
Small sample size requiring further confirmation in a larger number of patients
Inability to confirm specific precipitating factors involved in the development of electrical storms
Role of vagal tone in specific weekdays or seasons was not directly evident
Lack of genetic testing data

Implication

Weekend and winter/spring clustering distinguishes Brugada storms from isolated VF; hypothesis-generating for timing-based risk stratification.

Abstract

In patients with Brugada syndrome (BS), VF occurred predominantly during the nocturnal period. Some patients also developed ESs. In addition to the circadian rhythm, patients showed weekly and seasonal patterns. The patients with ESs had peak episodes of VF on Saturday and in the winter and spring, while episodes of VF in patients with single VF events occurred most often on Monday with smaller seasonal variation. Except for age, there was no difference in the clinical or ECG characteristics between the patients with ESs and those with single VF episodes.

Discussion

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Cite This Study

Aizawa et al. (2016) conducted a cohort in Brugada syndrome with ventricular fibrillation or electrical storm (n=44). Electrical storm (≥3 separate episodes of VF/24 h) vs. Single episode of ventricular fibrillation was evaluated on Weekend occurrence (Saturday and Sunday) of ventricular fibrillation episodes (p=0.035). Electrical storms in Brugada syndrome occurred more frequently on weekends than single VF events (47.4% vs 12.3%, P=0.035) and peaked in winter/spring (66.7%, P=0.012).

synapsesocial.com/papers/6ade7f9cdc05956c13ef4193 https://doi.org/10.1016/j.ijcha.2016.05.008

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Comparison of circadian, weekly, and seasonal variations of electrical storms and single events of ventricular fibrillation in patients with Brugada syndrome

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Comparison of circadian, weekly, and seasonal variations of electrical storms and single events of ventricular fibrillation in patients with Brugada syndrome

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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