Low-voltage type 1 ECG is associated with fatal ventricular tachyarrhythmia in brugada syndrome

Satoshi Nagase, Tsukasa Kamakura, Naoya Kataoka, Mitsuru Wada, Kenichiro Yamagata, Kohei Ishibashi, Yuko Y. Inoue, Koji Miyamoto, Takashi Noda, Takeshi Aiba, Chisato Izumi, Teruo Noguchi, Satoshi Yasuda, Wataru Shimizu, Shiro Kamakura, Kengo Kusano

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)

Abstract

Background—Epicardial mapping can reveal low-voltage areas on the right ventricular outflow tract in patients with Brugada syndrome with several ventricular fibrillation (VF) episodes. A type 1 ECG is associated with an abnormal electrogram on right ventricular outflow tract epicardium. This study investigated the clinical significance of the amplitude of type 1 ECGs in patients with Brugada syndrome. Methods and Results—In 209 patients with Brugada syndrome with a spontaneous type 1 ECG (26 resuscitated from VF, 54 with syncope, and 129 asymptomatic), the amplitude of the ECG in leads exhibiting type 1 was measured among V1 to V3 leads positioned in the standard and upper 1 and 2 intercostal spaces. The number of ECG leads exhibiting type 1 did not differ among groups. The averaged amplitude of type 1 ECG was, however, significantly smaller in the group resuscitated from VF than in the asymptomatic group (P<0.05). Moreover, the minimum amplitude of type 1 ECG was significantly smaller in the group resuscitated from VF than in the group with syncope and the asymptomatic group (P<0.05 and P<0.01, respectively). During follow-up (56±48 months), VF occurred in 29 patients. Kaplan-Meier analysis revealed that patients with the minimum amplitude of type 1 ECG lower than or at the median value had a higher incidence of VF (log-rank test, P<0.01). In multivariate analysis, syncope, past VF episode, and minimum amplitude of type 1 ECG ≤0.8 mV were independent predictors of VF events during follow-up. Conclusions—Low-voltage type 1 ECG is highly and independently related to fatal ventricular tachyarrhythmia in patients with Brugada syndrome.

Original languageEnglish
Article numbere009713
JournalJournal of the American Heart Association
Volume7
Issue number21
DOIs
Publication statusPublished - 2018 Nov 1
Externally publishedYes

Keywords

  • Brugada syndrome
  • Electrocardiography
  • Sudden cardiac death
  • Ventricular fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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