1
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Sabbag A, Amoroso G, Tomer O, Conte G, Beinart R, Nof E, Özkartal T, Ollitrault P, Laredo M, Tovia‐Brodie O, Gandjbakhch E, de Benedictis M, ter Bekke RMA, Milman A. Clinical differences between drug-induced type 1 Brugada pattern and syndrome. J Arrhythm 2024; 40:982-990. [PMID: 39139869 PMCID: PMC11317691 DOI: 10.1002/joa3.13053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 08/15/2024] Open
Abstract
Background Diagnosis of Brugada syndrome (BrS) may be established by exposing a Type 1 Brugada pattern using a sodium channel blocker. Data on the outcomes of different patient populations with drug-induced Type 1 Brugada pattern are limited. The present study reports on the characteristics and outcome of subjects with ajmaline induced Type 1 Brugada pattern. Methods A multicenter retrospective study including all consecutive cases of ajmaline-induced Type 1 Brugada pattern from seven centers. Results A total of 260 patients (69.9% males, mean age 43.4 ± 13.5) were included. Additional characteristics included history of syncope (n = 56, 21.5%), family history of BrS (n = 58, 22.3%) or sudden cardiac death (n = 47, 18.1%) and ventricular fibrillation (n = 3, 1.2%). Patients were divided into those meeting current diagnostic criteria for drug-induced BrS (DIBrS) and compared to the drug-induced Brugada pattern (DIBrECG). Females were significantly overrepresented in the DIBrS group (n = 50, 40% vs. n = 29, 21.5%, p = .001). A significantly higher prevalence of type 2/3 Brugada ECG at baseline was found in the DIBrECG group (n = 108, 80.8% vs. n = 75, 60% in the DIBrS, p = .026). During a median follow up of three (IQR 1.50-5.32) years, a single event of significant arrhythmia occurred in the DIBrS group. Conclusion Less than half of subjects with ajmaline-induced Brugada pattern met current criteria for BrS. These individuals had very low rate of adverse outcomes during a follow up of 3 years, irrespective of the indication for the test or eligibility for the BrS diagnosis.
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Affiliation(s)
- Avi Sabbag
- Leviev Heart InstituteThe Chaim Sheba Medical CenterTel HashomerIsrael
- Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | | | - Orr Tomer
- Leviev Heart InstituteThe Chaim Sheba Medical CenterTel HashomerIsrael
- Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | | | - Roy Beinart
- Leviev Heart InstituteThe Chaim Sheba Medical CenterTel HashomerIsrael
- Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Eyal Nof
- Leviev Heart InstituteThe Chaim Sheba Medical CenterTel HashomerIsrael
- Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | | | - Pierre Ollitrault
- Electrophysiology Unit, Cardiology Department, Caen University HospitalUnicaenCaenFrance
| | - Mikael Laredo
- Sorbonne Université, AP‐HP, Groupe Hospitalier Pitié‐SalpêtrièreInstitut de CardiologieParisFrance
| | - Oholi Tovia‐Brodie
- Jesselson Integrated Heart CenterShaare Zedek Medical CenterJerusalemIsrael
| | - Estelle Gandjbakhch
- Electrophysiology Unit, Cardiology Department, Caen University HospitalUnicaenCaenFrance
| | | | - Rachel M. A. ter Bekke
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM)Maastricht University Medical CenterMaastrichtthe Netherlands
| | - Anat Milman
- Leviev Heart InstituteThe Chaim Sheba Medical CenterTel HashomerIsrael
- Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
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2
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Călburean PA, Pannone L, Monaco C, Rocca DD, Sorgente A, Almorad A, Bala G, Aglietti F, Ramak R, Overeinder I, Ströker E, Pappaert G, Măru'teri M, Harpa M, La Meir M, Brugada P, Sieira J, Sarkozy A, Chierchia GB, de Asmundis C. Predicting and Recognizing Drug-Induced Type I Brugada Pattern Using ECG-Based Deep Learning. J Am Heart Assoc 2024; 13:e033148. [PMID: 38726893 PMCID: PMC11179812 DOI: 10.1161/jaha.123.033148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/28/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Brugada syndrome (BrS) has been associated with sudden cardiac death in otherwise healthy subjects, and drug-induced BrS accounts for 55% to 70% of all patients with BrS. This study aims to develop a deep convolutional neural network and evaluate its performance in recognizing and predicting BrS diagnosis. METHODS AND RESULTS Consecutive patients who underwent ajmaline testing for BrS following a standardized protocol were included. ECG tracings from baseline and during ajmaline were transformed using wavelet analysis and a deep convolutional neural network was separately trained to (1) recognize and (2) predict BrS type I pattern. The resultant networks are referred to as BrS-Net. A total of 1188 patients were included, of which 361 (30.3%) patients developed BrS type I pattern during ajmaline infusion. When trained and evaluated on ECG tracings during ajmaline, BrS-Net recognized a BrS type I pattern with an AUC-ROC of 0.945 (0.921-0.969) and an AUC-PR of 0.892 (0.815-0.939). When trained and evaluated on ECG tracings at baseline, BrS-Net predicted a BrS type I pattern during ajmaline with an AUC-ROC of 0.805 (0.845-0.736) and an AUC-PR of 0.605 (0.460-0.664). CONCLUSIONS BrS-Net, a deep convolutional neural network, can identify BrS type I pattern with high performance. BrS-Net can predict from baseline ECG the development of a BrS type I pattern after ajmaline with good performance in an unselected population.
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Affiliation(s)
- Paul-Adrian Călburean
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart Brussels Belgium
- University of Medicine, Pharmacy, Science and Technology "George Emil Palade" of Târgu Mureş Târgu Mureş Romania
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart Brussels Belgium
| | - Cinzia Monaco
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart Brussels Belgium
| | - Domenico Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart Brussels Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart Brussels Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart Brussels Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart Brussels Belgium
| | - Filippo Aglietti
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart Brussels Belgium
| | - Robbert Ramak
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart Brussels Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart Brussels Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart Brussels Belgium
| | - Gudrun Pappaert
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart Brussels Belgium
| | - Marius Măru'teri
- University of Medicine, Pharmacy, Science and Technology "George Emil Palade" of Târgu Mureş Târgu Mureş Romania
| | - Marius Harpa
- University of Medicine, Pharmacy, Science and Technology "George Emil Palade" of Târgu Mureş Târgu Mureş Romania
| | - Mark La Meir
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart Brussels Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart Brussels Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart Brussels Belgium
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart Brussels Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart Brussels Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, European Reference Networks Guard-Heart Brussels Belgium
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3
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Camkiran V, Ozden O, Atar I. Long-term follow-up of patients with Brugada syndrome: Foremost risk factors associated with overall arrhythmic events. Medicine (Baltimore) 2024; 103:e37990. [PMID: 38701276 PMCID: PMC11062732 DOI: 10.1097/md.0000000000037990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/02/2024] [Indexed: 05/05/2024] Open
Abstract
Brugada syndrome (BS) is characterized by ST segment elevation in right precordial leads (V1-V3), ventricular tachycardia (VT), ventricular fibrillation (VF), and sudden cardiac death (SCD) in individuals without structural heart disease. The aim of this study is to contribute to the controversial issue of finding the most valuable marker that can predict poor prognosis during follow-up in patients with a diagnosis of BS. A total of 68 patients diagnosed with BS or had Brugada-type ECG change between January 1997 and July 2012 at the Department of Cardiology of Başkent University Faculty of Medicine, Ankara, Turkey, were included in this cohort study. Patients were screened every 6 months for arrhythmia-related syncope, SCD, appropriate and inappropriate defibrillation (shock), AF development and death; collectively defined as "arrhythmic events" and were the primary endpoints. Patients with and without arrhythmic events were compared. The mean age was 34.9 ± 12.2 years (9-71 years), and 52 (76.5%) patients were male. Mean follow-up was 49.6 ± 37.6 months (4-188 months). Univariate analysis showed that male sex (P = .004), type 1 electrocardiographic pattern (P = .008), SCD (P = .036), VT/VF history (P = .046), requirement for electrophysiological studies (P = .034), implantable cardioverter-defibrillator placement (P = .014) were found to demonstrate significant differences in patients with and without arrhythmic events. In multivariable analyzes, spontaneous type 1 ECG presence (HR = 8.54, 95% CI: 0.38-26.37; P = .003) and VT/VF history (HR = 9.21, 95% CI: 0.004-1.88; P = .002) were found to be independently associated with arrhythmic events. We found the presence of spontaneous type 1 ECG and a history of VT/VF to be associated with increased likelihood of overall arrhythmic events in BS. Given the higher risk of poor prognosis, we recommend additional measures in patients with BS who have these features.
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Affiliation(s)
- Volkan Camkiran
- Department of Cardiology, Goztepe Medicalpark Hospital, Istanbul, Turkey
| | - Ozge Ozden
- Department of Cardiology, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Ilyas Atar
- Department of Cardiology, Private Clinic, Ankara, Turkey
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4
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Călburean PA, Pannone L, Sorgente A, Gauthey A, Monaco C, Strazdas A, Almorad A, Bisignani A, Bala G, Ramak R, Overeinder I, Ströker E, Pappaert G, Van Dooren S, de Ravel T, La Meir M, Brugada P, Sieira J, Chierchia GB, de Asmundis C. Heart rate variability and microvolt T wave alternans changes during ajmaline test may predict prognosis in Brugada syndrome. Clin Auton Res 2023; 33:51-62. [PMID: 36645559 DOI: 10.1007/s10286-023-00922-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/03/2023] [Indexed: 01/17/2023]
Abstract
PURPOSE Drug-induced type I Brugada syndrome (BrS) is associated with a ventricular arrhythmia (VA) rate of 1 case per 100 person-years. This study aims to evaluate changes in electrocardiographic (ECG) parameters such as microvolt T wave alternans (mTWA) and heart rate variability (HRV) at baseline and during ajmaline testing for BrS diagnosis. METHODS Consecutive patients diagnosed with BrS during ajmaline testing with 5-year follow-up were included in this study. For comparison, a negative ajmaline control group and an isoproterenol control group were also included. ECG recordings during ajmaline or isoproterenol test were divided in two timeframes from which ECG parameters were calculated: a 5-min baseline timeframe and a 5-min drug timeframe. RESULTS A total of 308 patients with BrS were included, 22 (0.7%) of which suffered VAs during follow-up. One hundred patients were included in both isoproterenol and negative ajmaline control groups. At baseline, there was no difference in ECG parameters between control groups and patients with BrS, nor between BrS with and without VAs. During ajmaline testing, BrS with VAs presented longer QRS duration [159 ± 34 ms versus 138 (122-155) ms, p = 0.006], higher maximum mTWA [33.8 (14.0-114) µV versus 8.00 (3.67-28.2) µV, p = 0.001], and lower power in low frequency band [25.6 (5.8-53.8) ms2 versus 129.5 (52.7-286) ms2, p < 0.0001] when compared to BrS without VAs. CONCLUSIONS Ajmaline induced important HRV changes similar to those observed during isoproterenol. Increased mTWA was observed only in patients with BrS. BrS with VAs during follow-up presented worse changes during ajmaline test, including lower LF power and higher maximum mTWA which were independent predictors of events.
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Affiliation(s)
- Paul-Adrian Călburean
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium.,George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Anaïs Gauthey
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Cinzia Monaco
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Antanas Strazdas
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Antonio Bisignani
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Robbert Ramak
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Gudrun Pappaert
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Sonia Van Dooren
- Genetics Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Thomy de Ravel
- Genetics Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Mark La Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090, Brussels, Belgium.
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5
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Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, Charron P, Corrado D, Dagres N, de Chillou C, Eckardt L, Friede T, Haugaa KH, Hocini M, Lambiase PD, Marijon E, Merino JL, Peichl P, Priori SG, Reichlin T, Schulz-Menger J, Sticherling C, Tzeis S, Verstrael A, Volterrani M. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022; 43:3997-4126. [PMID: 36017572 DOI: 10.1093/eurheartj/ehac262] [Citation(s) in RCA: 849] [Impact Index Per Article: 424.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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6
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Iacopino S. Risk Stratification in Brugada Syndrome: Never Forget the Electrocardiogram. Am J Cardiol 2022; 167:164-165. [PMID: 34986987 DOI: 10.1016/j.amjcard.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Saverio Iacopino
- Arrhythmology Department,Maria Cecilia Hospital, Cotignola, Italy
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7
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Martínez-Barrios E, Cesar S, Cruzalegui J, Hernandez C, Arbelo E, Fiol V, Brugada J, Brugada R, Campuzano O, Sarquella-Brugada G. Clinical Genetics of Inherited Arrhythmogenic Disease in the Pediatric Population. Biomedicines 2022; 10:106. [PMID: 35052786 PMCID: PMC8773373 DOI: 10.3390/biomedicines10010106] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/27/2021] [Accepted: 12/31/2021] [Indexed: 12/19/2022] Open
Abstract
Sudden death is a rare event in the pediatric population but with a social shock due to its presentation as the first symptom in previously healthy children. Comprehensive autopsy in pediatric cases identify an inconclusive cause in 40-50% of cases. In such cases, a diagnosis of sudden arrhythmic death syndrome is suggested as the main potential cause of death. Molecular autopsy identifies nearly 30% of cases under 16 years of age carrying a pathogenic/potentially pathogenic alteration in genes associated with any inherited arrhythmogenic disease. In the last few years, despite the increasing rate of post-mortem genetic diagnosis, many families still remain without a conclusive genetic cause of the unexpected death. Current challenges in genetic diagnosis are the establishment of a correct genotype-phenotype association between genes and inherited arrhythmogenic disease, as well as the classification of variants of uncertain significance. In this review, we provide an update on the state of the art in the genetic diagnosis of inherited arrhythmogenic disease in the pediatric population. We focus on emerging publications on gene curation for genotype-phenotype associations, cases of genetic overlap and advances in the classification of variants of uncertain significance. Our goal is to facilitate the translation of genetic diagnosis to the clinical area, helping risk stratification, treatment and the genetic counselling of families.
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Affiliation(s)
- Estefanía Martínez-Barrios
- Arrhythmias Unit, Hospital Sant Joan de Déu, University of Barcelona, 08007 Barcelona, Spain; (E.M.-B.); (S.C.); (J.C.); (C.H.); (V.F.); (J.B.)
| | - Sergi Cesar
- Arrhythmias Unit, Hospital Sant Joan de Déu, University of Barcelona, 08007 Barcelona, Spain; (E.M.-B.); (S.C.); (J.C.); (C.H.); (V.F.); (J.B.)
| | - José Cruzalegui
- Arrhythmias Unit, Hospital Sant Joan de Déu, University of Barcelona, 08007 Barcelona, Spain; (E.M.-B.); (S.C.); (J.C.); (C.H.); (V.F.); (J.B.)
| | - Clara Hernandez
- Arrhythmias Unit, Hospital Sant Joan de Déu, University of Barcelona, 08007 Barcelona, Spain; (E.M.-B.); (S.C.); (J.C.); (C.H.); (V.F.); (J.B.)
| | - Elena Arbelo
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain; (E.A.); (R.B.)
- Arrhythmias Unit, Hospital Clinic, University of Barcelona-IDIBAPS, 08036 Barcelona, Spain
| | - Victoria Fiol
- Arrhythmias Unit, Hospital Sant Joan de Déu, University of Barcelona, 08007 Barcelona, Spain; (E.M.-B.); (S.C.); (J.C.); (C.H.); (V.F.); (J.B.)
| | - Josep Brugada
- Arrhythmias Unit, Hospital Sant Joan de Déu, University of Barcelona, 08007 Barcelona, Spain; (E.M.-B.); (S.C.); (J.C.); (C.H.); (V.F.); (J.B.)
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain; (E.A.); (R.B.)
- Arrhythmias Unit, Hospital Clinic, University of Barcelona-IDIBAPS, 08036 Barcelona, Spain
| | - Ramon Brugada
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain; (E.A.); (R.B.)
- Medical Science Department, School of Medicine, University of Girona, 17004 Girona, Spain
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain
- Cardiology Service, Hospital Josep Trueta, University of Girona, 17007 Girona, Spain
| | - Oscar Campuzano
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain; (E.A.); (R.B.)
- Medical Science Department, School of Medicine, University of Girona, 17004 Girona, Spain
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain
| | - Georgia Sarquella-Brugada
- Arrhythmias Unit, Hospital Sant Joan de Déu, University of Barcelona, 08007 Barcelona, Spain; (E.M.-B.); (S.C.); (J.C.); (C.H.); (V.F.); (J.B.)
- Medical Science Department, School of Medicine, University of Girona, 17004 Girona, Spain
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8
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Iacopino S, Chierchia GB, Sorrenti P, Pesce F, Colella J, Fabiano G, Campagna G, Petretta A, Placentino F, Filannino P, Artale P, Giacopelli D, Santarpino G, Sorgente A, Brugada P, de Asmundis C. dST-Tiso Interval, a Novel Electrocardiographic Marker of Ventricular Arrhythmia Inducibility in Individuals With Ajmaline-Induced Brugada Type I Pattern. Am J Cardiol 2021; 159:94-99. [PMID: 34503825 DOI: 10.1016/j.amjcard.2021.08.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
The aim of this study was to investigate the reliability of a novel electrocardiographic (ECG) marker in predicting ventricular arrhythmia (VA) inducibility in individuals with drug-induced Brugada syndrome (BrS) type I pattern. Consecutive patients with drug-induced type I BrS pattern underwent programmed ventricular stimulation (PVS) and, according to their response, were divided into 2 groups. Clinical characteristics and 12-lead ECG intervals before and after ajmaline infusion were compared between the 2 groups. A novel ECG marker named dST-Tiso interval consisting in the interval between the onset of the coved ST-segment elevation and its termination at the isoelectric line was also evaluated. Our cohort included 76 individuals (median age 44 years, 75% male). Twenty-five (32.9%) had VA inducibility requiring defibrillation. As compared with not inducible subjects, those with VA inducibility were more frequently male (92% vs 65%, p = 0.013), had longer PQ interval (basal: 172 vs 152 ms, p = 0.033; after ajmaline: 216 vs 200 ms, p = 0.040), higher J peak (0.6 vs 0.5 mV, p = 0.006) and longer dST-Tiso (360 vs 240 ms, p < 0.001). The dST-Tiso showed a C-statistics of 0.90 (95% confidence interval: 0.82 to 0.99) and an adjusted odds ratio for VA of 1.03 (1.01 to 1.04, p < 0.001). A dST-Tiso interval >300 ms yielded a sensitivity of 92.0%, a specificity of 90.2%, positive and negative predictive values of 82.1% and 95.8%. In conclusion, the dST-Tiso interval is a powerful predictor of VA inducibility in drug-induced BrS type I pattern. External validation is needed, but this marker might be useful in the clinical counseling process of these individuals before invasive PVS.
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