Neurally mediated syncope as a cause of syncope in patients with brugada electrocardiogram

Miki Yokokawa, Hideo Okamura, Takashi Noda, Kazuhiro Satomi, Kazuhiro Suyama, Takashi Kurita, Naohiko Aihara, Shiro Kamakura, Wataru Shimizu

Research output: Contribution to journalArticlepeer-review

46 Citations (Scopus)


Neurally Mediated Syncope in Brugada Syndrome. Introduction: Patients with type 1 Brugada electrocardiogram (ECG) and an episode of syncope are diagnosed as symptomatic Brugada syndrome; however, all episodes of syncope may not be due to ventricular tachyarrhythmia. Methods and Results: Forty-six patients with type 1 Brugada ECG (all males, 51 ± 13 years, 29 spontaneous, 17 Ic-drug induced), 20 healthy control subjects (all males, 35 ± 11 years), and 15 patients with suspected neurally mediated syncope (NMS; 9 males, 54 ± 22 years) underwent the head-up tilt (HUT) test. During the HUT test, 12-lead ECGs were recorded in all patients, and the heart rate variability was investigated in some patients. Sixteen (35%) of 46 patients with Brugada ECG, 2 (10%) of 20 control subjects, and 10 (67%) of 15 patients with suspected NMS showed positive responses to the HUT test. Although no significant differences were observed in HUT-positive rate among Brugada patients with documented VT (7/14; 50%), syncope (5/19; 26%) and asymptomatic patients (4/13; 31%), the HUT-positive rate was significantly higher in patients with documented VT (50%) and those with VT or no symptoms (11/27, 41%) compared to that in control subjects (10%) (P < 0.05). Augmentation of ST-segment amplitude (≥0.05 mV) in leads V1-V3 was observed in 11 (69%) of 16 HUT-positive patients with Brugada ECG during vasovagal responses, and was associated with augmentation of parasympathetic tone following sympathetic withdrawal. Conclusion: Thirty-five percent of patients with Brugada ECG showed vasovagal responses during the HUT test, suggesting that some Brugada patients have impaired balance of autonomic nervous system, which may relate to their syncopal episodes.

Original languageEnglish
Pages (from-to)186-192
Number of pages7
JournalJournal of Cardiovascular Electrophysiology
Issue number2
Publication statusPublished - 2010 Feb
Externally publishedYes


  • Autonomic nervous system
  • Brugada syndrome
  • Head-up tilt test
  • Sudden death
  • Syncope

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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