Clinical and electrocardiographic differences in brugadsyndrome with spontaneous or drug-induced type 1 electrocardiogram

Tomomi Nagayama, Satoshi Nagase, Tsukasa Kamakura, Mitsuru Wada, Kohei Ishibashi, Yuko Y. Inoue, Koji Miyamoto, Takashi Noda, Takeshi Aiba, Hiroshi Takaki, Masaru Sugimachi, Wataru Shimizu, Teruo Noguchi, Satoshi Yasuda, Shiro Kamakura, Kengo Kusano

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)532-539
Number of pages8
JournalCirculation Journal
Volume83
Issue number3
DOIs
Publication statusPublished - 2019 Feb 25
Externally publishedYes

Keywords

  • Brugada syndrome
  • Type 1 electrocardiogram
  • Ventricular fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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