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Bisignani A, Conte G, Pannone L, Sieira J, Del Monte A, Lipartiti F, Bala G, Miraglia V, Monaco C, Ströker E, Overeinder I, Almorad A, Gauthey A, Franchetti Pardo L, Raes M, Detriche O, Brugada P, Auricchio A, Chierchia GB, de Asmundis C. Long-Term Outcomes of Pulmonary Vein Isolation in Patients With Brugada Syndrome and Paroxysmal Atrial Fibrillation. J Am Heart Assoc 2022; 11:e026290. [PMID: 35862178 PMCID: PMC9375506 DOI: 10.1161/jaha.122.026290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Pharmacological treatment of atrial fibrillation (AF) in the setting of Brugada syndrome (BrS) is challenging. In addition, patients with BrS with an implantable cardioverter-defibrillator (ICD) might experience inappropriate shocks for fast AF. Long-term outcome of pulmonary vein isolation in BrS has not been well established yet, and it is still unclear whether pulmonary vein triggers are the only pathophysiological mechanism of AF in BrS. The aim of the study is to assess the long-term outcomes in patients with BrS undergoing pulmonary vein isolation for paroxysmal AF compared with a matched cohort of patients without BrS. Methods and Results Sixty patients with BrS undergoing pulmonary vein isolation with cryoballoon catheter ablation for paroxysmal AF were matched with 60 patients without BrS, who underwent the same procedure. After a mean follow-up of 58.2±31.7 months, freedom from atrial tachyarrhythmias was achieved in 61.7% in the BrS group and in 78.3% in the non-BrS group (log-rank P=0.047). In particular, freedom from AF was 76.7% in the first group and in 83.3% in the second (P=0.27), while freedom from atrial tachycardia/atrial flutter was 85% and 95% (P=0.057). In the BrS group, 29 patients (48.3%) had an ICD and 8 (27.6%) had a previous ICD-inappropriate shock for fast AF. In the BrS cohort, ICD-inappropriate interventions for AF were significantly reduced after ablation (3.4% versus 27.6%; P=0.01). Conclusions Pulmonary vein isolation in patients with BrS was associated with higher rate of arrhythmic recurrence. Despite this, catheter ablation significantly reduced inappropriate ICD interventions in BrS patients and can be considered a therapeutic strategy to prevent inappropriate device therapies.
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Affiliation(s)
- Antonio Bisignani
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium.,Institute of Cardiology Università Cattolica del Sacro Cuore Rome Italy
| | - Giulio Conte
- Division of Cardiology Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale Lugano Switzerland
| | - Luigi Pannone
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Juan Sieira
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Alvise Del Monte
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Felicia Lipartiti
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Gezim Bala
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Vincenzo Miraglia
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Cinzia Monaco
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Erwin Ströker
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Ingrid Overeinder
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Alexandre Almorad
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Anaïs Gauthey
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Livia Franchetti Pardo
- Division of Cardiology Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale Lugano Switzerland
| | - Matthias Raes
- Anaesthesiology Department Vrije Universiteit Brussel Brussels Belgium
| | - Olivier Detriche
- Anaesthesiology Department Vrije Universiteit Brussel Brussels Belgium
| | - Pedro Brugada
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Angelo Auricchio
- Division of Cardiology Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale Lugano Switzerland
| | - Gian-Battista Chierchia
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Carlo de Asmundis
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
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Abstract
Atrial fibrillation (AF), the common sustained arrhythmia in clinical practice, has major public health implications due to its associated morbidity and increased mortality. The AF epidemic is due to the burgeoning elderly population and the identification of novel risk factors, for example, genetics. Since the diagnosis of AF has a major impact on the clinical assessment and management of patients with inherited arrhythmia syndromes, improved understanding of the cause and pathogenesis of AF has provided important insights into the underlying pathophysiological mechanisms of this common arrhythmia and identified potential mechanism-based therapies.
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Affiliation(s)
- Baha'a Al-Azaam
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 820 S Wood Street, Suite 920S, Chicago, IL 60612, USA; Division of Cardiology, Department of Pharmacology, University of Illinois at Chicago, 820 S Wood Street, Suite 920S, Chicago, IL 60612, USA
| | - Dawood Darbar
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 820 S Wood Street, Suite 920S, Chicago, IL 60612, USA; Division of Cardiology, Department of Pharmacology, University of Illinois at Chicago, 820 S Wood Street, Suite 920S, Chicago, IL 60612, USA; Department of Medicine, Jesse Brown Veterans Administration, 820 S Wood Street, Suite 920S, Chicago, IL 60612, USA.
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3
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Vlachos K, Mascia G, Martin CA, Bazoukis G, Frontera A, Cheniti G, Letsas KP, Efremidis M, Georgopoulos S, Gkalapis C, Duchateau J, Parmbrun T, Derval N, Hocini M, Haissaguerre M, Jais P, Sacher F. Atrial fibrillation in Brugada syndrome: Current perspectives. J Cardiovasc Electrophysiol 2020; 31:975-984. [DOI: 10.1111/jce.14361] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/10/2020] [Accepted: 01/15/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Konstantinos Vlachos
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
| | - Giuseppe Mascia
- Cardiology and Electrophysiology UnitAzienda USL Toscana Florence Italy
| | - Claire A. Martin
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
- Department of Electrophysiology‐CardiologyRoyal Papworth Hospital Cambridge UK
| | - George Bazoukis
- Laboratory of Electrophysiology, Second Department of CardiologyGeneral Hospital of Athens “Evangelismos" Athens Greece
| | - Antonio Frontera
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
| | - Ghassen Cheniti
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
| | - Konstantinos P. Letsas
- Laboratory of Electrophysiology, Second Department of CardiologyGeneral Hospital of Athens “Evangelismos" Athens Greece
| | - Micheal Efremidis
- Laboratory of Electrophysiology, Second Department of CardiologyGeneral Hospital of Athens “Evangelismos" Athens Greece
| | - Stamatis Georgopoulos
- Laboratory of Electrophysiology, Second Department of CardiologyGeneral Hospital of Athens “Evangelismos" Athens Greece
| | - Charis Gkalapis
- Department of Electrophysiology‐CardiologyKlinikum Vest Recklinghausen Germany
- Department of Cardiology, Akademisches LehrkrankenhausRuhr‐Universität Bochum Bochum Germany
| | - Josselin Duchateau
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
| | - Thomas Parmbrun
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
| | - Nicholas Derval
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
| | - Mélèze Hocini
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
| | - Michel Haissaguerre
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
| | - Pierre Jais
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
| | - Frédéric Sacher
- Hôpital Cardiologique du Haut LévèqueCHU de Bordeaux and IHU‐LIRYC Pessac France
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Rodríguez‐Mañero M, Kreidieh B, Valderrábano M, Baluja A, Martínez‐Sande JL, García‐Seara J, Díaz‐Fernández B, Pereira‐Vázquez M, Lage R, González‐Melchor L, Fernández‐López XA, González‐Juanatey JR. Ablation of atrial fibrillation in patients with Brugada syndrome: A systematic review of the literature. J Arrhythm 2019; 35:18-24. [PMID: 30805040 PMCID: PMC6373661 DOI: 10.1002/joa3.12113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/26/2018] [Accepted: 08/01/2018] [Indexed: 01/10/2023] Open
Abstract
Supraventricular arrhythmias are common in Brugada syndrome (BS), and notoriously difficult to manage with medical therapy secondary to associated risks. Pulmonary vein isolation (PVI) is often utilized instead, but its outcomes in this population are not well-known. We aim to provide a holistic evaluation of interventional treatment for Atrial fibrillation (AF) in the BS population. Electronic databases Medline, Embase, Cinahl, Cochrane, and Scopus were systematically searched for publications between 01/01/1995 and 12/31/2017. Studies were screened based on predefined inclusion and exclusion criteria. A total of 49 patients with BS and AF were included. Age range from 28.8 to 64 years, and 77.5% were male. 38 patients were implanted with implantable cardioverter-defibrillators (ICD) at baseline, and of them, 39% suffered inappropriate shocks for rapid AF. 34/49 (69%) of patients achieved remission following a single PVI procedure. Of the remaining, 13 patients underwent one or more repeat ablation procedures. Overall, 45/49 (91.8%) of patients remained in remission during long-term follow-up after one or more PVI procedures in the absence of antiarrhythmic drug (AAD) therapy. Postablation, no patients suffered inappropriate ICD shock. Furthermore, no major complications secondary to PVI occurred in any patient. AF ablation achieves acute and long-term success in the vast majority of patients. It is effective in preventing inappropriate ICD therapy secondary to rapid AF. Complication rates of PVI in BS are low. Thus, in light of the risks of AADs and risk of inappropriate ICD shocks in the BS population, catheter ablation could represent an appropriate first-line therapy for paroxysmal atrial fibrillation in BS patients.
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Affiliation(s)
- Moisés Rodríguez‐Mañero
- Division of Cardiac ElectrophysiologyCardiology DepartmentUniversity Hospital Santiago de CompostelaSantiago de CompostelaSpain
- Instituto de Investigación Sanitaria (IDIS)Universidad de Santiago de CompostelaSantiago de CompostelaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV CB16/11/00226‐CB16/11/00420)Spain
| | - Bahij Kreidieh
- University of Miami/JFK Medical Center Palm Beach Regional GME ConsortiumMiami, FLUSA
| | - Miguel Valderrábano
- Division of Cardiac ElectrophysiologyDepartment of CardiologyMethodist HospitalHoustonTXUSA
| | - Aurora Baluja
- Division of Cardiac ElectrophysiologyCardiology DepartmentUniversity Hospital Santiago de CompostelaSantiago de CompostelaSpain
| | - Jose Luis Martínez‐Sande
- Division of Cardiac ElectrophysiologyCardiology DepartmentUniversity Hospital Santiago de CompostelaSantiago de CompostelaSpain
- Instituto de Investigación Sanitaria (IDIS)Universidad de Santiago de CompostelaSantiago de CompostelaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV CB16/11/00226‐CB16/11/00420)Spain
| | - Javier García‐Seara
- Division of Cardiac ElectrophysiologyCardiology DepartmentUniversity Hospital Santiago de CompostelaSantiago de CompostelaSpain
- Instituto de Investigación Sanitaria (IDIS)Universidad de Santiago de CompostelaSantiago de CompostelaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV CB16/11/00226‐CB16/11/00420)Spain
| | - Brais Díaz‐Fernández
- Division of Cardiac ElectrophysiologyCardiology DepartmentUniversity Hospital Santiago de CompostelaSantiago de CompostelaSpain
| | - María Pereira‐Vázquez
- Division of Cardiac ElectrophysiologyCardiology DepartmentUniversity Hospital Santiago de CompostelaSantiago de CompostelaSpain
| | - Ricardo Lage
- Division of Cardiac ElectrophysiologyCardiology DepartmentUniversity Hospital Santiago de CompostelaSantiago de CompostelaSpain
- Instituto de Investigación Sanitaria (IDIS)Universidad de Santiago de CompostelaSantiago de CompostelaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV CB16/11/00226‐CB16/11/00420)Spain
| | - Laila González‐Melchor
- Division of Cardiac ElectrophysiologyCardiology DepartmentUniversity Hospital Santiago de CompostelaSantiago de CompostelaSpain
| | - Xesús A. Fernández‐López
- Division of Cardiac ElectrophysiologyCardiology DepartmentUniversity Hospital Santiago de CompostelaSantiago de CompostelaSpain
- Instituto de Investigación Sanitaria (IDIS)Universidad de Santiago de CompostelaSantiago de CompostelaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV CB16/11/00226‐CB16/11/00420)Spain
| | - José Ramón González‐Juanatey
- Division of Cardiac ElectrophysiologyCardiology DepartmentUniversity Hospital Santiago de CompostelaSantiago de CompostelaSpain
- Instituto de Investigación Sanitaria (IDIS)Universidad de Santiago de CompostelaSantiago de CompostelaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV CB16/11/00226‐CB16/11/00420)Spain
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5
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Mugnai G, Hünük B, Ströker E, Ruggiero D, Coutino-Moreno HE, Takarada K, De Regibus V, Choudhury R, Abugattas de Torres JP, Moran D, Iacopino S, Filannino P, Conte G, Sieira J, Poelaert J, Beckers S, Brugada P, de Asmundis C, Chierchia GB. Long-term outcome of pulmonary vein isolation in patients with paroxysmal atrial fibrillation and Brugada syndrome. Europace 2018; 20:548-554. [PMID: 28340057 DOI: 10.1093/europace/euw428] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 12/07/2016] [Indexed: 11/13/2022] Open
Abstract
Aims The therapeutical management of atrial fibrillation (AF) in the setting of Brugada syndrome (BS) might be challenging as many antiarrhythmic drugs (AADs) with sodium channel blocking properties might lead to to the development of ventricular arrhythmias. This study sought to evaluate the clinical outcome in a consecutive series of patients with BS having undergone pulmonary vein (PV) isolation by means of radiofrequency (RF) or cryoballoon (CB) ablation and the efficacy of catheter ablation for preventing inappropriate interventions delivered by implantable cardioverter defibrillators (ICD) on a 3-year follow up. Methods and results Twenty-three consecutive patients with BS (13 males; mean age was 47 ± 18 years) having undergone PV isolation for drug-resistant paroxysmal AF were enrolled. Eleven patients (48%) had an ICD implanted of whom four had inappropriate shocks secondary to rapid AF. Over a mean follow-up period of 35.0 ± 25.4 months (median 36 months) the freedom from AF recurrence after the index PV isolation procedure was 74% without AADs. Patients with inappropriate ICD interventions for AF did not present futher ICD shocks after AF ablation. No major complications occurred. Conclusion Catheter ablation is a valid therapeutic choice for patients with BS and paroxysmal AF considering the high success rates, the limitations of the AADs and the safety of the procedure, and it should be taken into consideration especially in those patients presenting inappropriate ICD shocks due to rapid AF.
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Affiliation(s)
- Giacomo Mugnai
- Heart Rhythm Management Center, UZ Brussel-VUB Laarbeklaan 101, 1090 Brussels, Belgium
| | - Burak Hünük
- Heart Rhythm Management Center, UZ Brussel-VUB Laarbeklaan 101, 1090 Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Center, UZ Brussel-VUB Laarbeklaan 101, 1090 Brussels, Belgium
| | - Diego Ruggiero
- Heart Rhythm Management Center, UZ Brussel-VUB Laarbeklaan 101, 1090 Brussels, Belgium
| | | | - Ken Takarada
- Heart Rhythm Management Center, UZ Brussel-VUB Laarbeklaan 101, 1090 Brussels, Belgium
| | - Valentina De Regibus
- Heart Rhythm Management Center, UZ Brussel-VUB Laarbeklaan 101, 1090 Brussels, Belgium
| | - Rajin Choudhury
- Heart Rhythm Management Center, UZ Brussel-VUB Laarbeklaan 101, 1090 Brussels, Belgium
| | | | - Darragh Moran
- Heart Rhythm Management Center, UZ Brussel-VUB Laarbeklaan 101, 1090 Brussels, Belgium
| | - Saverio Iacopino
- Electrophysiology Unit, Maria Cecilia Hospital, via Corriera 1, 48033 Cotignola (RA), Italy
| | - Pasquale Filannino
- Electrophysiology Unit, Maria Cecilia Hospital, via Corriera 1, 48033 Cotignola (RA), Italy
| | - Giulio Conte
- Heart Rhythm Management Center, UZ Brussel-VUB Laarbeklaan 101, 1090 Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Center, UZ Brussel-VUB Laarbeklaan 101, 1090 Brussels, Belgium
| | - Jan Poelaert
- Department of Anaesthesiology, UZ Brussel-VUB Laarbeklaan 101, 1090 Brussels, Belgium
| | - Stefan Beckers
- Department of Anaesthesiology, UZ Brussel-VUB Laarbeklaan 101, 1090 Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Center, UZ Brussel-VUB Laarbeklaan 101, 1090 Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Center, UZ Brussel-VUB Laarbeklaan 101, 1090 Brussels, Belgium
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Enriquez A, Antzelevitch C, Bismah V, Baranchuk A. Atrial fibrillation in inherited cardiac channelopathies: From mechanisms to management. Heart Rhythm 2016; 13:1878-84. [DOI: 10.1016/j.hrthm.2016.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Indexed: 10/21/2022]
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Kitamura T, Fukamizu S, Kawamura I, Hojo R, Aoyama Y, Komiyama K, Nishizaki M, Hiraoka M, Sakurada H. Long-term efficacy of catheter ablation for paroxysmal atrial fibrillation in patients with Brugada syndrome and an implantable cardioverter-defibrillator to prevent inappropriate shock therapy. Heart Rhythm 2016; 13:1455-9. [DOI: 10.1016/j.hrthm.2016.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Indexed: 10/22/2022]
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Hasdemir C. Atrial arrhythmias in inherited arrhythmogenic disorders. J Arrhythm 2016; 32:366-372. [PMID: 27761160 PMCID: PMC5063273 DOI: 10.1016/j.joa.2015.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 11/17/2015] [Indexed: 12/19/2022] Open
Abstract
Atrial arrhythmias are being increasingly recognized in inherited arrhythmogenic disorders particularly in patients with Brugada syndrome and short QT syndrome. Atrial arrhythmias in inherited arrhythmogenic disorders have significant epidemiologic, clinical, and prognostic implications. There has been progress in the understanding of underlying genetic characteristics and the mechanistic link between atrial arrhythmias and inherited arrhythmogenic disorders. Appropriate management of these patients is of paramount importance.
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Affiliation(s)
- Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Bornova, Izmir 35100, Turkey
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9
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[Brugada ECG]. Herzschrittmacherther Elektrophysiol 2015; 26:247-59. [PMID: 26249049 DOI: 10.1007/s00399-015-0391-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 07/15/2015] [Indexed: 10/23/2022]
Abstract
The Brugada syndrome (BrS) is characterized by a typical electrocardiogram (ECG) pattern of right precordial ST-segment elevation and the cardinal symptoms syncope and sudden cardiac death as clinical correlate of malignant ventricular arrhythmias in young adults without structural heart disease. The diagnosis of a type 1 Brugada-ECG is based on the documentation of a coved-type (≥ 0.2 mV) ST elevation followed by a negative T wave. The use of the ECG criteria postulated in the consensus of 2012 is helpful to distinguish between saddleback-type 2 (or type 3) J point/ST elevation and incomplete right bundle branch block. Spontaneous or drug-induced type 1 ST elevation can frequently only be detected in a single right precordial lead (V1 or V2), occurs sometimes together with a type 2 (or type 3) pattern in one and the same 12-lead ECG and can sometimes only be seen in modified right precordial leads. The ST elevation is less pronounced in females. Spontaneous and exercise-induced type 1 ST elevation, fragmented QRS complex, prolonged PR interval (> 200 ms), QRS prolongation in V2 (≥ 120 ms) and markers of an increased heterogeneity of ventricular repolarization are associated with an increased arrhythmic risk. The occurrence of spontaneous or dynamic type 1 ST elevation, a macroscopic T wave alternans or pronounced inferior (lateral) J point/ST elevation are signs of acute electrical instability.
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Atrial fibrillation in a large population with Brugada electrocardiographic pattern: prevalence, management, and correlation with prognosis. Heart Rhythm 2014; 11:259-65. [PMID: 24513919 DOI: 10.1016/j.hrthm.2013.10.043] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND A high prevalence of atrial fibrillation/atrial flutter (AF/AFl) has been reported in small series of Brugada patients, with discordant data. OBJECTIVE The purpose of this study was to analyze, in a large population of Brugada patients, the prevalence of AF/AFl, its correlation with prognosis, and the efficacy of hydroquinidine (HQ) treatment. METHODS Among 560 patients with Brugada type 1 ECG (BrECG), 48 (9%) had AF/AFl. Three groups were considered: 23 patients with BrECG pattern recognized before AF/AFl (group 1); 25 patients first diagnosed with AF/AFl in whom Class IC antiarrhythmic drugs administered for cardioversion/prophylaxis unmasked BrECG (group 2); and 512 patients without AF/AFl (group 3). Recurrence of AF/AFl and occurrence of ventricular arrhythmias were evaluated at follow-up. RESULTS Mean age was 47 ± 15 years, 59 ± 11 years, and 44 ± 14 years in groups 1, 2, and 3, respectively. Seven subjects (32%) in group 1 had syncope/aborted sudden death, 1 (4%) in group 2, and 122 (24%) in group 3. Ventricular arrhythmia occurred in three patients in group 1, none in group 2, and 10 in group 3 at median follow-up of 51, 68, and 41 months, respectively. Nine patients in group 1 and nine in group 2 received HQ for AF/AFl prophylaxis; on therapy, none had AF/AFl recurrence. CONCLUSION Prevalence of AF/AFl in Brugada patients is higher than in the general population of the same age. Patients in group 1 are younger than those in group 2 and have a worse prognosis compared to both groups 2 and 3. HQ therapy has proved useful and safe in patients with AF/AFl and BrECG.
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11
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Conte G, Chierchia GB, Wauters K, De Asmundis C, Sarkozy A, Levinstein M, Sieira J, Baltogiannis G, Di Giovanni G, Ciconte G, Casado-Arroyo R, Saitoh Y, Brugada P. Pulmonary vein isolation in patients with Brugada syndrome and atrial fibrillation: a 2-year follow-up. Europace 2013; 16:528-32. [PMID: 24108229 DOI: 10.1093/europace/eut309] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Pharmacological treatment of atrial fibrillation (AF) in the setting of Brugada syndrome (BS) might be challenging as many antiarrhythmic drugs (AADs) with sodium channel blocking properties might expose the patients to the development of ventricular arrhythmias. Moreover, patients with BS and implantable cardioverter-defibrillator (ICD) might experience inappropriate shocks because of AF with rapid ventricular response. The role of pulmonary vein isolation (PVI) in patients with BS and recurrent episodes of AF has not been established yet. In this study, we analysed the outcome of PVI using radiofrequency energy or cryoballoon (CB) ablation at 2 years follow-up. METHODS AND RESULTS Consecutive patients with BS having undergone PVI for drug-resistant paroxysmal AF were eligible for this study. Nine patients (three males; mean age: 52 ± 26 years) were included. Six patients (67%) had an ICD implanted of whom three had inappropriate shocks because of rapid AF. At a mean 22.1 ± 6.4 months follow-up, six patients (67%) were free of AF without AADs. None of the three patients who had experienced inappropriate ICD interventions for AF had further ICD shocks after ablation. CONCLUSION In our study PVI can be an effective and safe procedure to treat patients with BS and recurrent episodes of paroxysmal AF.
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Affiliation(s)
- Giulio Conte
- Heart Rhythm Management Centre, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium
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Sairaku A, Yoshida Y, Nakano Y, Kihara Y. Ablation of atrial fibrillation in Brugada syndrome patients with an implantable cardioverter defibrillator to prevent inappropriate shocks resulting from rapid atrial fibrillation. Int J Cardiol 2013; 168:5273-6. [DOI: 10.1016/j.ijcard.2013.08.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 07/17/2013] [Accepted: 08/03/2013] [Indexed: 11/27/2022]
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13
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Kim AS, Huffer L. Atrial Fibrillation and Brugada Syndrome. Card Electrophysiol Clin 2012; 4:249-257. [PMID: 26939822 DOI: 10.1016/j.ccep.2012.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Since its first description in 1992, the Brugada syndrome (BrS) has attracted significant attention from the cardiology community because of its association with malignant ventricular arrhythmias and sudden cardiac death. Supraventricular tachyarrhythmias in BrS represent a unique and seemingly higher-risk clinical subgroup of patients with BrS. Atrial fibrillation represents the most common supraventricular arrhythmia in patients with BrS, with average ranges reported in the literature of 20% to 40%. This article summarizes the current literature regarding the patient with BrS with atrial fibrillation and discusses the management of these clinically challenging and potentially higher-risk individuals.
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Affiliation(s)
- Andrew S Kim
- Cardiology Service, Department of Medicine, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA
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14
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Left atrial thickness under the catheter ablation lines in patients with paroxysmal atrial fibrillation: insights from 64-slice multidetector computed tomography. Heart Vessels 2012; 28:360-8. [DOI: 10.1007/s00380-012-0253-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 03/30/2012] [Indexed: 10/28/2022]
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Muggenthaler M, Behr ER. Brugada syndrome and atrial fibrillation: pathophysiology and genetics. Europace 2011; 13:913-5. [PMID: 21454331 DOI: 10.1093/europace/eur094] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Kofune M, Watanabe I, Ohkubo K, Ashino S, Okumura Y, Nagashima K, Nakai T, Kasamaki Y, Hirayama A. Abnormal Atrial Repolarization and Depolarization Contribute to the Inducibility of Atrial Fibrillation in Brugada Syndrome. Int Heart J 2010; 51:159-65. [DOI: 10.1536/ihj.51.159] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Masayoshi Kofune
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Ichiro Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Kimie Ohkubo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Sonoko Ashino
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Toshiko Nakai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yuji Kasamaki
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
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Yamada T, Yoshida N, Murakami Y, Okada T, Yoshida Y, Muto M, Inden Y, Murohara T. The difference in autonomic denervation and its effect on atrial fibrillation recurrence between the standard segmental and circumferential pulmonary vein isolation techniques. Europace 2009; 11:1612-9. [PMID: 19875397 DOI: 10.1093/europace/eup330] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS This study examined the difference in autonomic modification (AM) and its effect on paroxysmal atrial fibrillation (PAF) recurrence between segmental pulmonary vein isolation (S-PVI) and circumferential PVI (C-PVI). METHODS AND RESULTS Successful S-PVI or C-PVI with a basket catheter was achieved in 120 consecutive PAF patients. Serial 24 Holter-recordings were obtained before, immediately, and 1, 3, 6, 12 months after the PVI to analyse the heart rate variability (HRV). Nineteen patients were excluded from analysis because of additional ablation for recurrent PAF after successful PVI. Among the residual 101 patients, 33 had PAF recurrences (S-PVI = 44.0%, C-PVI = 21.6%) at 1 year of follow-up. The root mean square of successive differences and high-frequency power reflecting parasympathetic nervous activity were significantly lower in patients with and without PAF recurrences after C-PVI and patients without PAF recurrences after S-PVI than patients with PAF recurrences after S-PVI (P < 0.005-0.0001). However, there were no significant differences in any HRV parameters in the immediate aftermath of PVI among the patients without PAF recurrences after S-PVI and those with and without PAF recurrences after C-PVI. CONCLUSION Although additional radiofrequency ablation for AM may be recommended after S-PVI to reduce PAF recurrences, it should be carefully determined after C-PVI.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, 1670 University Boulevard, 1530 3rd Avenue S., Birmingham, AL, USA.
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Sakhuja R, Shah AJ, Keebler M, Thakur RK. Atrial fibrillation in patients with implantable defibrillators. Cardiol Clin 2009; 27:151-61, ix-x. [PMID: 19111771 DOI: 10.1016/j.ccl.2008.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Atrial fibrillation (AF) is common in patients who have implantable defibrillators and presents some unique challenges and opportunities. AF burden can be assessed more accurately, allowing for evaluation of therapy efficacy (drugs or ablation). It remains to be shown whether home monitoring of defibrillators to detect and treat AF more quickly can reduce cardiovascular and stroke end points. One major goal will be to reduce inappropriate shocks from atrial fibrillation. Otherwise, the goals of therapy remain the same-reduction of symptoms (including heart failure exacerbation and inappropriate implantable cardioverter defibrillator therapies) by controlling rate or rhythm and anticoagulation for stroke prophylaxis.
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Affiliation(s)
- Rahul Sakhuja
- Massachusetts General Hospital, Division of Cardiology, 55 Fruit Street, Boston, MA 02114, USA
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Current World Literature. Curr Opin Cardiol 2009; 24:95-101. [DOI: 10.1097/hco.0b013e32831fb366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Long QT syndrome: Not just a ventricular problem. Heart Rhythm 2008; 5:710-1. [DOI: 10.1016/j.hrthm.2008.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Indexed: 11/24/2022]
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