1
|
Brito J, Cortez-Dias N, da Silva GL, Ferreira AN, Ricardo IA, Cunha N, António PS, Neves I, Paiva S, Paixão A, Gaspar F, Silva A, Magalhães A, Marques P, Pinto FJ, de Sousa J. Association between the number of altered late potential criteria and increased arrhythmic risk in Brugada syndrome patients. J Interv Card Electrophysiol 2024; 67:1133-1143. [PMID: 37966657 DOI: 10.1007/s10840-023-01685-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Brugada syndrome (BrS) is associated with abnormal electrophysiological properties at right ventricular epicardium, consisting of fragmented electrograms extending well beyond QRS termination. We aimed to evaluate the utility of signal-averaged electrocardiogram (SA-ECG) for the noninvasive assessment of late potentials (LP) and risk stratification of BrS patients. METHODS A prospective, observational, single-center study of BrS patients is submitted to SA-ECG with the determination of the total filtered QRS duration (fQRS), root mean square voltage of the 40 ms terminal portion of the QRS (RMS40), and duration of the low-amplitude electric potential component of the terminal portion of the QRS (LAS40). LP were considered positive when above standard cut-offs: fQRS > 114 ms, RMS40 < 20 µV, and LAS40 > 38 ms. The rates of malignant arrhythmic events (MAEs), defined as sudden death or appropriate shocks, were compared in relation to clinical characteristics and SA-ECG findings. RESULTS A total of 106 BrS patients (mean age, 48 ± 12 years, 67.9% male) were studied, 49% with type-1 spontaneous pattern and 81% asymptomatic. During a median follow up of 4.7 years, 10 patients (7.1%) suffered MAEs, including 4 sudden deaths. The presence of LP was significantly associated with the arrhythmic risk, which increased with the number of altered LP criteria. In comparison to the patients who had none or 1 altered LP criterium, MAE risk was 4.7 times higher in those with 2 altered criteria and 9.4 times higher in those with 3 altered LP criteria. CONCLUSIONS SA-ECG may be a useful tool for risk stratification in BrS. The presence of 2 or 3 abnormal LP criteria could identify a subset of asymptomatic patients at high risk of arrhythmic events.
Collapse
Affiliation(s)
- Joana Brito
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal.
| | - Nuno Cortez-Dias
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - Gustavo Lima da Silva
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - Afonso Nunes Ferreira
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - Inês Aguiar Ricardo
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - Nelson Cunha
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - Pedro Silvério António
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - Irina Neves
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - Sandra Paiva
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - Ana Paixão
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - Fernanda Gaspar
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - Adília Silva
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - Andreia Magalhães
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - Pedro Marques
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - Fausto J Pinto
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| | - João de Sousa
- Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal
| |
Collapse
|
2
|
Lee S, Wong WT, Wong ICK, Mak C, Mok NS, Liu T, Tse G. Ventricular Tachyarrhythmia Risk in Paediatric/Young vs. Adult Brugada Syndrome Patients: A Territory-Wide Study. Front Cardiovasc Med 2021; 8:671666. [PMID: 34179137 PMCID: PMC8225934 DOI: 10.3389/fcvm.2021.671666] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/18/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction: Brugada syndrome (BrS) is a cardiac ion channelopathy with a higher prevalence in Asia compared to the Western populations. The present study compared the differences in clinical and electrocardiographic (ECG) presentation between paediatric/young (≤25 years old) and adult (>25 years) BrS patients. Method: This was a territory-wide retrospective cohort study of consecutive BrS patients presenting to public hospitals in Hong Kong. The primary outcome was spontaneous ventricular tachycardia/ventricular fibrillation (VT/VF). Results: The cohort consists of 550 consecutive patients (median age of initial presentation = 51 ± 23 years; female = 7.3%; follow-up period = 83 ± 80 months), divided into adult (n = 505, mean age of initial presentation = 52 ± 19 years; female = 6.7%; mean follow-up period = 83 ± 80 months) and paediatric/young subgroups (n = 45, mean age of initial presentation = 21 ± 5 years, female = 13.3%, mean follow-up period = 73 ± 83 months). The mean annual VT/VF incidence rate were 17 and 25 cases per 1,000 patient-year, respectively. Multivariate analysis showed that initial presentation of type 1 pattern (HR = 1.80, 95% CI = [1.02, 3.15], p = 0.041), initial asymptomatic presentation (HR = 0.26, 95% CI = [0.07, 0.94], p = 0.040) and increased P-wave axis (HR = 0.98, 95% CI = [0.96, 1.00], p = 0.036) were significant predictors of VT/VF for the adult subgroup. Only initial presentation of VT/VF was predictive (HR = 29.30, 95% CI = [1.75, 492.00], p = 0.019) in the paediatric/young subgroup. Conclusion: Clinical and ECG presentation of BrS vary between the paediatric/young and adult population in BrS. Risk stratification and management strategies for younger patients should take into consideration and adopt an individualised approach.
Collapse
Affiliation(s)
- Sharen Lee
- Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong, China
| | - Wing Tak Wong
- State Key Laboratory of Agrobiotechnology (CUHK), School of Life Sciences, Chinese University of Hong Kong, Hong Kong, China
| | - Ian Chi Kei Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,School of Pharmacy, University College London, London, United Kingdom
| | - Chloe Mak
- Department of Pathology, Hong Kong Children's Hospital, Hong Kong, China
| | - Ngai Shing Mok
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.,Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom.,Kent and Medway Medical School, Canterbury, United Kingdom
| |
Collapse
|