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Wülfers EM, Moss R, Lehrmann H, Arentz T, Westermann D, Seemann G, Odening KE, Steinfurt J. Whole-heart computational modelling provides further mechanistic insights into ST-elevation in Brugada syndrome. Int J Cardiol Heart Vasc 2024; 51:101373. [PMID: 38464963 PMCID: PMC10924145 DOI: 10.1016/j.ijcha.2024.101373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/08/2024] [Accepted: 02/21/2024] [Indexed: 03/12/2024]
Abstract
Background Brugada syndrome (BrS) is characterized by dynamic ST-elevations in right precordial leads and increased risk of ventricular fibrillation and sudden cardiac death. As the mechanism underlying ST-elevation and malignant arrhythmias is controversial computational modeling can aid in exploring the disease mechanism. Thus we aim to test the main competing hypotheses ('delayed depolarization' vs. 'early repolarization') of BrS in a whole-heart computational model. Methods In a 3D whole-heart computational model, delayed epicardial RVOT activation with local conduction delay was simulated by reducing conductivity in the epicardial RVOT. Early repolarization was simulated by instead increasing the transient outward potassium current (Ito) in the same region. Additionally, a reduction in the fast sodium current (INa) was incorporated in both models. Results Delayed depolarization with local conduction delay in the computational model resulted in coved-type ST-elevation with negative T-waves in the precordial surface ECG leads. 'Saddleback'-shaped ST-elevation was obtained with reduced substrate extent or thickness. Increased Ito simulations showed early repolarization in the RVOT with a descending but not coved-type ST-elevation. Reduced INa did not show a significant effect on ECG morphology. Conclusions In this whole-heart BrS computational model of both major hypotheses, realistic coved-type ECG resulted only from delayed epicardial RVOT depolarization with local conduction delay but not early repolarizing ion channel modifications. These simulations provide further support for the depolarization hypothesis as electrophysiological mechanism underlying BrS.
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Affiliation(s)
- Eike M Wülfers
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg - Bad Krozingen, and Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Physics and Astronomy, Faculty of Sciences, Ghent University, Ghent, Belgium
| | - Robin Moss
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg - Bad Krozingen, and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Heiko Lehrmann
- Department of Cardiology and Angiology, University Heart Center Freiburg - Bad Krozingen, and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Arentz
- Department of Cardiology and Angiology, University Heart Center Freiburg - Bad Krozingen, and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, University Heart Center Freiburg - Bad Krozingen, and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gunnar Seemann
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg - Bad Krozingen, and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katja E Odening
- Translational Cardiology, Department of Cardiology and Institute of Physiology, University Hospital Bern, University of Bern, Switzerland
| | - Johannes Steinfurt
- Department of Cardiology and Angiology, University Heart Center Freiburg - Bad Krozingen, and Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Ahmed T, Lodhi SH, Haigh PJ, Sorrell VL. The many faces of takotsubo syndrome: A review. Curr Probl Cardiol 2024; 49:102421. [PMID: 38253114 DOI: 10.1016/j.cpcardiol.2024.102421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 01/24/2024]
Abstract
Takotsubo syndrome is a state of an acute heart failure featuring reversible left ventricular dysfunction. In recent years, the incidence of Takotsubo syndrome has risen 8-fold. In this case series and literature review, we present the rare presentations or complications of Takotsubo syndrome and highlight diagnostic or management strategies. We aim to raise the awareness on the pathologic spectrum of takotsubo syndrome for the clinicians encountering this challenging diagnosis.
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Affiliation(s)
- Taha Ahmed
- Department of Cardiovascular Medicine, Gill Heart & Vascular Institute, University of Kentucky, Lexington, KY, USA.
| | - Samra Haroon Lodhi
- Department of Cardiovascular Medicine, Gill Heart & Vascular Institute, University of Kentucky, Lexington, KY, USA
| | - Peter J Haigh
- Department of Cardiovascular Medicine, Gill Heart & Vascular Institute, University of Kentucky, Lexington, KY, USA
| | - Vincent L Sorrell
- Department of Cardiovascular Medicine, Gill Heart & Vascular Institute, University of Kentucky, Lexington, KY, USA
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Cacdac R, Lim A, Ghazaleh J, Salmasi S, Poursadrolah S, Jordan M, Rubin A. Type I Brugada Pattern in a Febrile Patient Following COVID-19 Vaccination Booster. J Investig Med High Impact Case Rep 2024; 12:23247096231210337. [PMID: 38299604 PMCID: PMC10836127 DOI: 10.1177/23247096231210337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 02/02/2024] Open
Abstract
There have been studies published regarding the association between developing Brugada syndrome after an acute COVID-19 infection. In this case, we present a patient who presented with a syncopal episode and subsequently found to have Type I Brugada pattern on electrocardiogram. The patient underwent placement of a single chamber defibrillator. Genetic analysis demonstrated SCN5A variant which is associated with cardiac conditions including Brugada syndrome.
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Affiliation(s)
| | - Anthony Lim
- Eisenhower Medical Center, Rancho Mirage, CA, USA
- Graduate Medical Education, Eisenhower Health and Annenberg Center for Health Sciences, Rancho Mirage, CA, USA
| | | | | | | | | | - Andrew Rubin
- Eisenhower Medical Center, Rancho Mirage, CA, USA
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Theisen B, Holtz A, Rajagopalan V. Noncoding RNAs and Human Induced Pluripotent Stem Cell-Derived Cardiomyocytes in Cardiac Arrhythmic Brugada Syndrome. Cells 2023; 12:2398. [PMID: 37830612 PMCID: PMC10571919 DOI: 10.3390/cells12192398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
Hundreds of thousands of people die each year as a result of sudden cardiac death, and many are due to heart rhythm disorders. One of the major causes of these arrhythmic events is Brugada syndrome, a cardiac channelopathy that results in abnormal cardiac conduction, severe life-threatening arrhythmias, and, on many occasions, death. This disorder has been associated with mutations and dysfunction of about two dozen genes; however, the majority of the patients do not have a definite cause for the diagnosis of Brugada Syndrome. The protein-coding genes represent only a very small fraction of the mammalian genome, and the majority of the noncoding regions of the genome are actively transcribed. Studies have shown that most of the loci associated with electrophysiological traits are located in noncoding regulatory regions and are expected to affect gene expression dosage and cardiac ion channel function. Noncoding RNAs serve an expanding number of regulatory and other functional roles within the cells, including but not limited to transcriptional, post-transcriptional, and epigenetic regulation. The major noncoding RNAs found in Brugada Syndrome include microRNAs; however, others such as long noncoding RNAs are also identified. They contribute to pathogenesis by interacting with ion channels and/or are detectable as clinical biomarkers. Stem cells have received significant attention in the recent past, and can be differentiated into many different cell types including those in the heart. In addition to contractile and relaxational properties, BrS-relevant electrophysiological phenotypes are also demonstrated in cardiomyocytes differentiated from stem cells induced from adult human cells. In this review, we discuss the current understanding of noncoding regions of the genome and their RNA biology in Brugada Syndrome. We also delve into the role of stem cells, especially human induced pluripotent stem cell-derived cardiac differentiated cells, in the investigation of Brugada syndrome in preclinical and clinical studies.
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Affiliation(s)
- Benjamin Theisen
- Department of Biomedical and Anatomical Sciences, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR 72401, USA
| | - Austin Holtz
- Department of Biomedical and Anatomical Sciences, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR 72401, USA
| | - Viswanathan Rajagopalan
- Department of Biomedical and Anatomical Sciences, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR 72401, USA
- Arkansas Biosciences Institute, Jonesboro, AR 72401, USA
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Al Jarallah M, Refat H, Loricchio ML, Dashti R, Brady PA, Rajan R, Talera B. Arrhythmogenic right ventricular cardiomyopathy mimicking Brugada - a case report. Ann Med Surg (Lond) 2023; 85:5035-5038. [PMID: 37811015 PMCID: PMC10553056 DOI: 10.1097/ms9.0000000000000933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/23/2023] [Indexed: 10/10/2023] Open
Abstract
We report a rare case of arrhythmogenic right ventricular cardiomyopathy (ARVC). Middle-aged Kuwaiti gentleman presented to a polyclinic with complaints of dizziness and palpitation. Electrocardiogram (ECG) at the polyclinic showed polymorphic ventricular tachycardia, and hence he was referred to our center. ECG at the emergency room showed a Brugada pattern with epsilon waves. Echo showed right ventricular dysfunction with pulmonary arterial hypertension. Magnetic resonance imaging showed evidence of ARVC. He was referred to the electrophysiology team and implanted an implantable cardioverter-defibrillator electively.
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Affiliation(s)
- Mohammed Al Jarallah
- Department of Cardiology, Sabah Al Ahmad Cardiac Center, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Hany Refat
- Department of Cardiology, Sabah Al Ahmad Cardiac Center, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Maria L. Loricchio
- Department of Cardiology, Sabah Al Ahmad Cardiac Center, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Raja Dashti
- Department of Cardiology, Sabah Al Ahmad Cardiac Center, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Peter A. Brady
- Department of Cardiology, Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Rajesh Rajan
- Department of Cardiology, Sabah Al Ahmad Cardiac Center, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Bhavesh Talera
- Department of Internal Medicine, Ivy Superspeciality Hospital, Sector 71, Mohali, Chandigarh, India
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Katz A, Balasubramanian S, Freedman Z. Procainamide-Provoked Brugada Pattern in a Patient Presenting with New-Onset Atrial Fibrillation or Flutter: When Does it Matter? J Emerg Med 2023; 65:e229-e233. [PMID: 37495422 DOI: 10.1016/j.jemermed.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/22/2023] [Accepted: 04/19/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Brugada syndrome (BrS) is an inherited disease that can lead to sudden cardiac death. Medications, such as antidysrhythmics, and fevers can unmask or induce the Brugada pattern on an electrocardiogram (ECG). This case report highlights a patient who developed drug-induced Brugada type I pattern after a procainamide infusion for the treatment of new-onset atrial fibrillation (AF) or flutter and discusses the implications for this incidental but potentially lethal finding. CASE REPORT We report a case of a young man who presented to the emergency department (ED) with new-onset AF with rapid ventricular response that began within 12 h of presentation. ED treatments included a crystalloid IV fluid bolus, diltiazem pushes, synchronized electrical cardioversion, and a procainamide infusion. After the procainamide infusion, the patient developed ECG findings consistent with Brugada pattern. Both the AF and Brugada pattern resolved spontaneously within 24 h. The patient was discharged without implantable cardioverter defibrillator placement due to presumed isolated procainamide-induced Brugada pattern and lack of concerning features, such as inducible dysrhythmia during electrophysiology study, family history of sudden death, and history of syncope. The patient was counseled to follow-up with genetics and avoid BrS-inducing medications. WHY SHOULD AN EMERGENCY PHYSICIANS BE AWARE OF THIS?: Procainamide, an option for the treatment of AF in the ED, can provoke Brugada pattern. If encountered, it is important to recall that some patients may not be diagnosed with BrS if determined to be low risk according to the Shanghai criteria. All patients should be referred to cardiology for further evaluation.
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Affiliation(s)
- Anne Katz
- Department of Emergency Medicine, Weill Cornell Medicine, New York, New York
| | - Shriman Balasubramanian
- Department of Emergency Medicine, New York-Presbyterian Hospital Cornell and Columbia, New York, New York
| | - Zachary Freedman
- Department of Emergency Medicine, New York-Presbyterian Hospital Cornell and Columbia, New York, New York
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Altermanini M, Habib MB, Alkhiyami D, Ali K, Abdelghani MS, Hamamyh T, Elyas A, Elhassan M. Syncope following Pfizer BioNTech (bnt162b2) vaccination unmasking Brugada syndrome. Heliyon 2023; 9:e18716. [PMID: 37576199 PMCID: PMC10415666 DOI: 10.1016/j.heliyon.2023.e18716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 07/10/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023] Open
Abstract
The Brugada syndrome is an uncommon inherited condition associated with increased risk of ventricular tachyarrhythmias and sudden cardiac death. Different triggers including fever are well known to precipitate the Brugada pattern on electrocardiogram. We report a patient who presents with syncope, two days after the first dose of the BNT162b2 vaccine due to fever-related unmasking of Brugada syndrome.
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Affiliation(s)
| | - Mhd Baraa Habib
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Khaled Ali
- Community Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Tahseen Hamamyh
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Elyas
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mawahib Elhassan
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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López Guillén JL, Sastre Albiach JM, Torres García MB, Maravall Llagaria MD. Autolytic attempt mimicking Brugada type 1 electrocardiogram pattern due to flecainide toxicity. A case report. Eur Heart J Case Rep 2023; 7:ytad337. [PMID: 37539350 PMCID: PMC10394301 DOI: 10.1093/ehjcr/ytad337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 07/06/2023] [Accepted: 07/19/2023] [Indexed: 08/05/2023]
Abstract
Background Brugada phenocopies are a group of heterogeneous disorders that mimic Brugada syndrome (BrS) electrocardiogram (ECG) changes elicited by reversible clinical conditions. We report a novel case on flecainide toxicity causing an ECG signature of Brugada type 1 pattern in the paediatric age. Case summary A 13-year-old Caucasian boy with untreated attention-deficit/hyperactivity disorder referred to the Pediatric Emergency Department (PED) after unknown antiarrhythmic drug overdose. He deliberately ingested 10 tablets from a labelled white box of a 100-mg single dose. The ECG showed a coved-type ST-segment elevation in right precordial leads and prolongation of PR segment with a QTc limit interval. Values of troponins gradually increased and echocardiogram was normal. The altered ECG pattern was explained by the stabilizing membrane effect of flecainide involving the inhibition of rapid Na+ channels. After offending drug removal, regression of ECG changes was observed and no cardiac events were documented during follow-up. Discussion Flecainide-induced Brugada type 1 ECG pattern may occur in patients with no evidence of genetic susceptibility receiving a toxic dosage of this drug. With increasing dose, its action on conduction pathways manifests as prolongation of PR interval and QT and QRS complex duration and may cause BrS mimicry. A detailed clinical history considering symptoms and ECG findings may support early-raised suspicion for flecainide ingestion. The therapeutic approach implies primary detoxification, prevention of potential triggers, and management of eventual cardiotoxicity events. Finally, risk stratification for BrS should be always measured according to the clinical scenario and surveillance considered in a timely manner.
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Moras E, Gandhi K, Narasimhan B, Brugada R, Brugada J, Brugada P, Krittanawong C. Genetic and Molecular Mechanisms in Brugada Syndrome. Cells 2023; 12:1791. [PMID: 37443825 PMCID: PMC10340412 DOI: 10.3390/cells12131791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
Brugada syndrome is a rare hereditary arrhythmia disorder characterized by a distinctive electrocardiogram pattern and an elevated risk of ventricular arrhythmias and sudden cardiac death in young adults. Despite recent advances, it remains a complex condition, encompassing mechanisms, genetics, diagnosis, arrhythmia risk stratification, and management. The underlying electrophysiological mechanism of Brugada syndrome requires further investigation, with current theories focusing on abnormalities in repolarization, depolarization, and current-load match. The genetic basis of the syndrome is strong, with mutations found in genes encoding subunits of cardiac sodium, potassium, and calcium channels, as well as genes involved in channel trafficking and regulation. While the initial discovery of mutations in the SCN5A gene provided valuable insights, Brugada syndrome is now recognized as a multifactorial disease influenced by several loci and environmental factors, challenging the traditional autosomal dominant inheritance model. This comprehensive review aims to provide a current understanding of Brugada syndrome, focusing on its pathophysiology, genetic mechanisms, and novel models of risk stratification. Advancements in these areas hold the potential to facilitate earlier diagnosis, improve risk assessments, and enable more targeted therapeutic interventions.
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Affiliation(s)
- Errol Moras
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Kruti Gandhi
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Bharat Narasimhan
- Debakey Cardiovascular Institute, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Ramon Brugada
- Cardiology, Cardiac Genetics Clinical Unit, Hospital Universitari Josep Trueta, Hospital Santa Caterina, 17007 Girona, Spain
- Cardiovascular Genetics Center and Clinical Diagnostic Laboratory, Institut d’Investigació Biomèdica Girona-IdIBGi, 17190 Salt, Spain
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, 08036 Barcelona, Spain
- Pediatric Arrhythmia Unit, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
- Department of Medicine, University of Barcelona, 08036 Barcelona, Spain
| | - Pedro Brugada
- Cardiovascular Division, Free University of Brussels (UZ Brussel) VUB, B-1050 Brussels, Belgium
- Medical Centre Prof. Brugada, B-9300 Aalst, Belgium
- Arrhythmia Unit, Helicopteros Sanitarios Hospital (HSH), Puerto Banús, 29603 Marbella, Spain
| | - Chayakrit Krittanawong
- Cardiology Division, NYU Langone Health and NYU School of Medicine, New York, NY 10016, USA
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Bernardelli A, Dossi F, Raccis M, Maggi R, Brignole M, Parodi G. Brugada ECG phenocopy in hypertrophic cardiomyopathy: The time matter. J Electrocardiol 2023; 77:1-3. [PMID: 36525869 DOI: 10.1016/j.jelectrocard.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022]
Abstract
An Implantable Cardioverter-Defibrillator was implanted in an asymptomatic 56-year-old man, with type 2 Brugada pattern on ECG, inducible ventricular fibrillation at elective electrophysiological study, and a family history of sudden cardiac death. Seventeen years later, the patient was admitted to the hospital due to palpitations related to a typical atrial flutter. A transthoracic echocardiogram unexpectedly revealed a clinically manifest hypertrophic cardiomyopathy.
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Liu K, Chen K, Uzunoglu EC, Rathore A, Deol T, Wu E, Elayi CS, Suryanarayana PG, Keim SG, Catanzaro JN. COVID-19-associated Brugada pattern electrocardiogram: Systematic review of case reports. Ann Noninvasive Electrocardiol 2023; 28:e13051. [PMID: 36811259 DOI: 10.1111/anec.13051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 01/21/2023] [Indexed: 02/24/2023] Open
Abstract
AIMS To summarize published case reports of patients diagnosed with coronavirus disease 2019 (COVID-19) and Brugada pattern electrocardiogram (ECG). METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist were followed. A literature search was conducted using PubMed, EMBASE, and Scopus up until September 2021. The incidence, clinical characteristics, and management outcomes of COVID-19 patients with a Brugada pattern ECG were identified. RESULTS A total of 18 cases were collected. The mean age was 47.1 years and 11.1% were women. No patients had prior confirmed diagnosis of Brugada syndrome. The most common presenting clinical symptoms were fever (83.3%), chest pain (38.8%), shortness of breath (38.8%), and syncope (16.6%). All 18 patients presented with type 1 Brugada pattern ECG. Four patients (22.2%) underwent left heart catheterization, and none demonstrated the presence of obstructive coronary disease. The most common reported therapies included antipyretics (55.5%), hydroxychloroquine (27.7%), and antibiotics (16.6%). One patient (5.5%) died during hospitalization. Three patients (16.6%) who presented with syncope received either an implantable cardioverter defibrillator or wearable cardioverter defibrillator at discharge. At follow-up, 13 patients (72.2%) had resolution of type 1 Brugada pattern ECG. CONCLUSION COVID-19-associated Brugada pattern ECG seems relatively rare. Most patients had resolution of the ECG pattern once their symptoms have improved. Increased awareness and timely use of antipyretics is warranted in this population.
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Affiliation(s)
- Kevin Liu
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, University of Florida Health Science Center, Florida, Jacksonville, USA
| | - Kai Chen
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, University of Florida Health Science Center, Florida, Jacksonville, USA
| | - Ekin C Uzunoglu
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, University of Florida Health Science Center, Florida, Jacksonville, USA
| | - Azeem Rathore
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, University of Florida Health Science Center, Florida, Jacksonville, USA
| | - Tanya Deol
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, University of Florida Health Science Center, Florida, Jacksonville, USA
| | - Ele Wu
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, University of Florida Health Science Center, Florida, Jacksonville, USA
| | - Claude S Elayi
- CHI Saint Joseph Hospital - Cardiology, Lexington, Kentucky, USA
| | - Prakash G Suryanarayana
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, University of Florida Health Science Center, Florida, Jacksonville, USA
| | - Stephen G Keim
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, University of Florida Health Science Center, Florida, Jacksonville, USA
| | - John N Catanzaro
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, University of Florida Health Science Center, Florida, Jacksonville, USA
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12
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Restrepo JA, MacLean R, Celano CM, Huffman JC, Januzzi JL, Beach SR. The assessment of cardiac risk in patients taking lamotrigine; a systematic review. Gen Hosp Psychiatry 2022; 78:14-27. [PMID: 35763920 DOI: 10.1016/j.genhosppsych.2022.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The Food and Drug Administration (FDA) warned about lamotrigine's arrhythmogenicity based on in vitro data. This systematic review investigates lamotrigine's effect on cardiac conduction and risk of sudden cardiac death (SCD) in individuals with and without cardiovascular disease. METHODS We searched Web of Science and PubMed from inception through August 2021. We included studies measuring electrocardiogram (ECG) changes, laboratory abnormalities, or SCD among patients taking lamotrigine. Studies examining sudden unexpected death in epilepsy were excluded for scope. Two reviewers assessed articles and extracted data. We used the Effective Public Healthcare Panacea Project tool to evaluate confidence in evidence. RESULTS Eight randomized controlled trials, 9 nonrandomized observational studies, and 24 case reports were identified, with >3054 total participants, >1606 of whom used lamotrigine. One randomized trial of older patients found an average QRS increase of 3.5 +/- 13.1 ms. Fifteen studies reported no changes in ECG parameters. Case reports documented QRS widening (13), Brugada syndrome (6), QTc prolongation (1) and SCD (2), though many ingested toxic quantities of lamotrigine and/or other medications. CONCLUSIONS Evidence is insufficient to support the breadth of the FDA warning concerning lamotrigine's cardiac risk. Lamotrigine at therapeutic doses may be associated with modest, non-dangerous QRS widening.
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Affiliation(s)
- Judith A Restrepo
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Rachel MacLean
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Christopher M Celano
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jeffery C Huffman
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - James L Januzzi
- Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Baim Institute for Clinical Research, 930 Commonwealth Avenue #3, Boston, MA 02215, United States of America
| | - Scott R Beach
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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13
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Mareddy C, ScM MT, McDaniel G, Monfredi O. Exercise in the Genetic Arrhythmia Syndromes - A Review. Clin Sports Med 2022; 41:485-510. [PMID: 35710274 DOI: 10.1016/j.csm.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Provide a brief summary of your article (100-150 words; no references or figures/tables). The synopsis appears only in the table of contents and is often used by indexing services such as PubMed. Genetic arrhythmia syndromes are rare, yet harbor the potential for highly consequential, often unpredictable arrhythmias or sudden death events. There has been historical uncertainty regarding the correct advice to offer to affected patients who are reasonably wanting to participate in sporting and athletic endeavors. In some cases, this had led to abundantly cautious disqualifications, depriving individuals from participation unnecessarily. Societal guidance and expert opinion has evolved significantly over the last decade or 2, along with our understanding of the genetics and natural history of these conditions, and the emphasis has switched toward shared decision making with respect to the decision to participate or not, with patients and families becoming better informed, and willing participants in the decision making process. This review aims to give a brief update of the salient issues for the busy physician concerning these syndromes and to provide a framework for approaching their management in the otherwise aspirational or keen sports participant.
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Affiliation(s)
- Chinmaya Mareddy
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, 1215 Lee St, Charlottesville, VA 22908, USA
| | - Matthew Thomas ScM
- Department of Pediatrics, P.O. Box 800386, Charlottesville, VA 22908, USA
| | - George McDaniel
- Department of Pediatric Cardiology, Battle Building 6th Floor, 1204 W. Main St, Charlottesville, VA 22903, USA
| | - Oliver Monfredi
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, 1215 Lee St, Charlottesville, VA 22908, USA.
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14
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Steinmetz K, Rudic B, Borggrefe M, Müller K, Siebert R, Rottbauer W, Ludolph A, Buckert D, Rosenbohm A. J wave syndromes in patients with spinal and bulbar muscular atrophy. J Neurol 2022; 269:3690-3699. [PMID: 35132468 PMCID: PMC9217903 DOI: 10.1007/s00415-022-10992-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Males with X-linked recessive spinobulbar muscular atrophy (SBMA) are reported to die suddenly and a Brugada electrocardiography (ECG) pattern may be present. A hallmark of this pattern is the presence of ST segment elevations in right precordial leads associated with an increased risk of sudden cardiac death. OBJECTIVE We aimed to detect subtle myocardial abnormalities using ECG and cardiovascular magnetic resonance imaging (CMR) in patients with SBMA. METHODS 30 SBMA patients (55.7 ± 11.9 years) and 11 healthy male controls underwent 12-lead ECGs were recorded using conventional and modified chest leads. CMR included feature-tracking strain analysis, late gadolinium enhancement and native T1 and T2 mapping. RESULTS Testosterone levels were increased in 6/29 patients. Abnormal ECGs were recorded in 70%, consisting of a Brugada ECG pattern, early repolarization or fragmented QRS. Despite normal left ventricular ejection fraction (66 ± 5%), SBMA patients exhibited more often left ventricular hypertrophy as compared to controls (34.5% vs 20%). End-diastolic volumes were smaller in SBMA patients (left ventricular volume index 61.7 ± 14.7 ml/m2 vs. 79.1 ± 15.5 ml/m2; right ventricular volume index 64.4 ± 16.4 ml/m2 vs. 75.3 ± 17.5 ml/m2). Tissue characterization with T1-mapping revealed diffuse myocardial fibrosis in SBMA patients (73.9% vs. 9.1%, device-specific threshold for T1: 1030 ms). CONCLUSION SBMA patients show abnormal ECGs and structural abnormalities, which may explain an increased risk of sudden death. These findings underline the importance of ECG screening, measurement of testosterone levels and potentially CMR imaging to assess cardiac risk factors.
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Affiliation(s)
- Karoline Steinmetz
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Boris Rudic
- 1st Department of Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- 1st Department of Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Kathrin Müller
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.,Institute of Human Genetics, University of Ulm and Ulm University Medical Center, Ulm, Germany
| | - Reiner Siebert
- Institute of Human Genetics, University of Ulm and Ulm University Medical Center, Ulm, Germany
| | | | - Albert Ludolph
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.,Deutsches Zentrum Für Neurodegenerative Erkrankungen (DZNE), Partner Site Ulm, Ulm, Germany
| | | | - Angela Rosenbohm
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
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15
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Attard A, Stanniland C, Attard S, Iles A, Rajappan K. Brugada syndrome: should we be screening patients before prescribing psychotropic medication? Ther Adv Psychopharmacol 2022; 12:20451253211067017. [PMID: 35111298 PMCID: PMC8801628 DOI: 10.1177/20451253211067017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/29/2021] [Indexed: 11/22/2022] Open
Abstract
Brugada syndrome (BrS) presents with a characteristic electrocardiogram (ECG) and is associated with sudden cardiac death. Until now, prolongation of QTc interval and its association with Torsade de Pointe and possible fatal arrhythmia have been the focus of routine baseline ECGs before prescribing psychotropic medication. A semi-systematic literature review was conducted using PubMed. The terms 'Brugada', 'Brugada Syndrome' AND 'psychotropic' 'antipsychotic' 'antidepressant' 'mood stabilisers' 'clozapine' 'Tricyclic Antidepressants' 'Lithium' were searched. From a search that delivered over 200 articles, 82 articles were included. Those that included details around causative medication, doses of medication and where clear timeline on drug cause were included. Where clarification was needed, the manufacturer of the medication was contacted directly. Psychotropic medication can be associated with BrS, Brugada phenocopy or unmasking of BrS, in overdose or in normal doses. Our results include a table summarising a number of psychotropic overdoses that led to BrS unmasking. Routine screening for BrS in patients before prescribing psychotropic medication is a natural extension of the baseline ECG currently routinely done to rule out QTc prolongation. Psychiatrists need to invest in ensuring better skills in interpreting ECGs and work closer with cardiologists in interpreting ECGs.
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Affiliation(s)
- Azizah Attard
- Department of Pharmacy, West London NHS Trust, Southall UB1 3EUN2 PCN, Virtually Healthcare, London
| | | | - Stephen Attard
- Central and North West London NHS Foundation Trust, London, UK
| | - Andrew Iles
- Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, UK
| | - Kim Rajappan
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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16
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De Maria E, Borghi A, Tonelli L, Selvatici R, Cappelli S, Gualandi F. Brugada ECG pattern in hypertrophic cardiomyopathy: Brugada phenocopy or overlapping syndrome? J Electrocardiol 2021; 69:132-5. [PMID: 34717131 DOI: 10.1016/j.jelectrocard.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 11/22/2022]
Abstract
The term phenocopy indicates a condition that imitates one produced by a gene and is also used for acquired Brugada-like ECG manifestations. Cases of Brugada phenocopies are increasingly reported in literature and an international registry is ongoing. We describe two patients with Hypertrophic Cardiomyopathy (HCM) and Brugada ECG pattern. Both patients carried the same pathogenic splicing mutation in MYBPC3 gene (responsible for HCM) while no genetic mutation associated with Brugada Syndrome was identified. To the best of our knowledge, Brugada ECG pattern has been rarely reported in patients with HCM.
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17
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Pearman CM, Walia J, Alqarawi W, Larsen JM, Leach E, Krahn AD, Laksman Z. The clinical utility of procainamide-induced late potentials on the signal averaged ECG. Pacing Clin Electrophysiol 2021; 44:2046-2053. [PMID: 34648655 DOI: 10.1111/pace.14379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Late potentials (LPs) identified on the signal averaged electrocardiogram (SAECG) are a marker for an increased risk of arrhythmias in Brugada syndrome (BrS). Procainamide is a sodium channel blocker used to diagnose BrS. The effects of Procainamide on the SAECG in those with BrS and the significance of Procainamide-induced LPs are unknown. METHODS Procainamide provocation was performed for suspected BrS with 12-lead and SAECG pre- and post-infusion. Filtered QRS duration (fQRSd), duration of low amplitude signals <40 μV (LAS40) and root-mean-square voltage in the terminal 40 ms (RMS40) were determined. RESULTS Data from 150 patients were included in the analysis (mean age 44.5 years, 109 males). Procainamide increased fQRSd (Pre 118.8 ± 10.5 ms, post 121.2 ± 10.2 ms, p < 0.001) and LAS40 (Pre 38.7 ± 9.8 ms, post 40.2 ± 10.5 ms, p = 0.005) and decreased RMS40 (Pre 24.6 ± 12 ms, post 22.8 ± 12 ms, p = 0.002). LPs were present in 68/150 (45%) at baseline. Fifteen patients with negative baseline SAECGs had LPs unmasked by Procainamide, but six patients had LPs at baseline that were no longer present following Procainamide. Comparing those with normal hearts (n = 48) to those with a final diagnosis of BrS (n = 38), Procainamide prolonged fQRSd to a greater extent in those with BrS. Comparing those with Procainamide-induced LPs to those with no LPs at any time did not highlight any aspect of phenotype and did not correlate with a history of ventricular arrhythmias. CONCLUSIONS Procainamide influences the SAECG, provoking LPs in a small proportion of patients. However, there is no evidence that Procainamide-induced LPs provide additional diagnostic information or aid risk stratification.
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Affiliation(s)
- Charles Michael Pearman
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada.,Unit of Cardiac Physiology, Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Jagdeep Walia
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Wael Alqarawi
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada.,Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,University of Ottawa Heart Institute, Ottawa, Canada
| | - Jacob Moesgaard Larsen
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Emma Leach
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Andrew D Krahn
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Zachary Laksman
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada
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18
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Nasarre M, Strik M, Daniel Ramirez F, Buliard S, Marchand H, Abu-Alrub S, Ploux S, Haïssaguerre M, Bordachar P. Using a smartwatch electrocardiogram to detect abnormalities associated with sudden cardiac arrest in young adults. Europace 2021; 24:406-412. [PMID: 34468759 DOI: 10.1093/europace/euab192] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/08/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Smartwatch electrocardiograms (ECGs) could facilitate the detection of sudden cardiac arrest (SCA)-associated abnormalities. We evaluated the feasibility of using smartwatch-derived ECGs for detecting SCA-associated abnormalities in young adults and its agreement with 12-lead ECGs. METHODS AND RESULTS Twelve-lead and Apple Watch ECGs were registered in 155 healthy volunteers and 67 patients aged 18-45 years with diagnosis and ECG signs of long-QT syndrome (n = 10), Brugada syndrome (n = 12), ventricular pre-excitation (n = 19), hypertrophic cardiomyopathy (HCM, n = 13), and arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVC/D, n = 13). Cardiologists separately analysed 12-lead ECGs and the smartwatch ECGs taken from the left wrist (AW-I) and then from chest positions V1, V3, and V6 (AW-4). Compared with AW-I, AW-4 improved the classification of ECGs as 'abnormal', increasing the sensitivity from 64% to 89% (P < 0.01). Pre-excitation was detected in most cases using AW-I (sensitivity 89%) and in all cases using AW-4 (sensitivity 100%, P = 0.48 compared with AW-I, specificity 100% for both). Brugada was missed using AW-I but was detected in 11/12 patients using AW-4 (sensitivity 92%, specificity 100%, P = 0.003). Long QT was detected in 8/10 cases using AW-I (sensitivity 80%, specificity 100%) and in 9 patients using AW-4 (sensitivity 90%, specificity 100%, P > 0.99). Hypertrophic cardiomyopathy was correctly suspected using AW-I and AW-4 (sensitivity 92% and 85%, specificity 85%, and 100%, P > 0.99). AW-I was mostly (62%) considered normal in ARVC/D whereas AW-4 was useful in suspecting ARVC/D (100% sensitivity, 99% specificity, P = 0.004). CONCLUSIONS Detection of SCA-associated ECG abnormalities (pre-excitation, Brugada patterns, long QT, and signs suggestive of HCM and ARVC/D) is possible with an ECG smartwatch.
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Affiliation(s)
- Mathieu Nasarre
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France
| | - Marc Strik
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France
| | - Francisco Daniel Ramirez
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France.,Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Samuel Buliard
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France
| | - Hugo Marchand
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France
| | - Saer Abu-Alrub
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France
| | - Sylvain Ploux
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France
| | - Michel Haïssaguerre
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France
| | - Pierre Bordachar
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France
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19
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Miyao S, Kubota Y, Nagino N, Egawa S, Nakamoto H, Fukuchi S, Kawamata T. [A case of cardiac arrest due to the appearance of Brugada-type electrocardiogram during epilepsy treatment]. Rinsho Shinkeigaku 2021; 61:466-470. [PMID: 34148935 DOI: 10.5692/clinicalneurol.cn-001573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The appearance of arrhythmias in epilepsy practice can lead to sudden death. This time, we experienced a case of cardiac arrest caused by lethal arrhythmia and resuscitation, and captured changes in the electrocardiogram over time from outpatient, before and after sudden change, after resuscitation, to convalescent period. QT prolongation and Brugada-type waveforms were confirmed in the changes over time in the electrocardiogram. Focusing on the importance of recognizing the pharmacological and pharmacokinetic interactions with Na channel blockers and psychotropic drugs that may induce electrocardiographic changes, we emphasized the importance of electrocardiogram in epilepsy treatment.
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Affiliation(s)
- Satoru Miyao
- Department of Epilepsy Center, TMG Asaka Medical Center
| | - Yuichi Kubota
- Department of Epilepsy Center, TMG Asaka Medical Center
| | - Naoto Nagino
- Department of Epilepsy Center, TMG Asaka Medical Center
| | - Satoshi Egawa
- Department of Epilepsy Center, TMG Asaka Medical Center
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20
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Guragai N, Vasudev R, Shah D, Singh B, Kaur P, Fernando A, Shamoon F, Pullatt R, Joshi M, Randhawa P. A Case of STEMI Masquerading Brugada Syndrome: Emphasizing the Importance of Clinical Decision Making in Emergencies. J Investig Med High Impact Case Rep 2021; 9:23247096211014060. [PMID: 34014107 PMCID: PMC8145585 DOI: 10.1177/23247096211014060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Brugada syndrome is a rare arrhythmogenic syndrome that is associated with an increased risk of ventricular fibrillation and sudden cardiac death. Electrocardiographic findings include patterns similar to a right bundle branch block (RBBB) and persistent ST-segment elevation in precordial leads (V1 and V2). There are numerous reports of Brugada syndrome mimicking ST-segment elevation myocardial infraction (STEMI); however, we describe a case of 47-year-old male who presented with STEMI mimics Brugada syndrome with preexisting RBBB. The patient developed polymorphic ventricular tachycardia generating into ventricular fibrillation right before catheterization making the diagnosis more challenging. The patient, eventually, was found to have obstructive coronary artery disease and no evidence of abnormal sodium channelopathy on further testing. This case highlights the importance of meticulous history taking and appropriate diagnostic test in establishing proper diagnosis of STEMI in a patient with preexisting RBBB, which can mimic Brugada syndrome.
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Affiliation(s)
| | - Rahul Vasudev
- St Joseph Regional Medical Center, Paterson, NJ, USA
| | - Dhaval Shah
- St Joseph Regional Medical Center, Paterson, NJ, USA
| | - Balraj Singh
- St Joseph Regional Medical Center, Paterson, NJ, USA
| | | | | | - Fayez Shamoon
- St Joseph Regional Medical Center, Paterson, NJ, USA
| | - Raja Pullatt
- Tinitas Regional Medical Center, Paterson, NJ, USA
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21
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Abstract
PURPOSE OF REVIEW To discuss the role of catheter ablation in treating life-threatening ventricular arrhythmias associated with Brugada syndrome (BrS), by presenting recent findings of BrS arrhythmogenic substrate, mechanisms underlying ventricular arrhythmias, and how they can be treated with catheter ablation. RECENT FINDINGS Almost three decades ago when the clinical entity of Brugada syndrome (BrS) was described in patients who had abnormal coved-type ST elevation in the right precordial EKG leads in patients who had no apparent structural heart disease but died suddenly from ventricular fibrillation. Since its description, the syndrome has galvanized explosive research in this field over the past decades, driving major progress toward better understanding of BrS, gaining knowledge of the genetic pathophysiology and risk stratification of BrS, and creating significant advances in therapeutic modalities. One of such advances is the ability for electrophysiologists to map and identify the arrhythmogenic substrate sites of BrS, which serve as good target sites for catheter ablation. Subsequently, several studies have shown that catheter ablation of these substrates normalizes the Brugada ECG pattern and is very effective in eliminating these substrates and preventing recurrent VF episodes. Catheter ablation has become an important addition for treatment of symptomatic BrS patients with recurrent VT/VF episodes.
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Affiliation(s)
- Ronpichai Chokesuwattanaskul
- Faculty of Medicine, Division of Cardiovascular Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Koonlawee Nademanee
- Faculty of Medicine, Division of Cardiovascular Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, 10330, Thailand. .,Bumrungrad Hospital, Bangkok, Thailand. .,Pacific Rim Electrophysiology Research Institute, Bangkok, Thailand. .,Pacific Rim Electrophysiology Research Institute, Las Vegas, Nevada, USA.
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22
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Pearman CM, Denham NC, Mills RW, Ding WY, Modi SS, Hall MCS, Todd DM, Mahida S. Relationship between sodium channel function and clinical phenotype in SCN5A variants associated with Brugada syndrome. Hum Mutat 2020; 41:2195-2204. [PMID: 33131149 PMCID: PMC7756571 DOI: 10.1002/humu.24128] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/23/2020] [Accepted: 10/09/2020] [Indexed: 12/19/2022]
Abstract
The identification of a pathogenic SCN5A variant confers an increased risk of conduction defects and ventricular arrhythmias (VA) in Brugada syndrome (BrS). However, specific aspects of sodium channel function that influence clinical phenotype have not been defined. A systematic literature search identified SCN5A variants associated with BrS. Sodium current (INa) functional parameters (peak current, decay, steady‐state activation and inactivation, and recovery from inactivation) and clinical features (conduction abnormalities [CA], spontaneous VA or family history of sudden cardiac death [SCD], and spontaneous BrS electrocardiogram [ECG]) were extracted. A total of 561 SCN5A variants associated with BrS were identified, for which data on channel function and clinical phenotype were available in 142. In the primary analysis, no relationship was found between any aspect of channel function and CA, VA/SCD, or spontaneous BrS ECG pattern. Sensitivity analyses including only variants graded pathogenic or likely pathogenic suggested that reduction in peak current and positive shift in steady‐state activation were weakly associated with CA and VA/SCD, although sensitivity and specificity remained low. The relationship between in vitro assessment of channel function and BrS clinical phenotype is weak. The assessment of channel function does not enhance risk stratification. Caution is needed when extrapolating functional testing to the likelihood of variant pathogenicity.
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Affiliation(s)
- Charles M Pearman
- Department of Cardiac Electrophysiology and Inherited Cardiac Conditions, Liverpool Heart and Chest Hospital, Liverpool, UK.,Unit of Cardiac Physiology, Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, Core Technology Facility, University of Manchester, Manchester, UK
| | - Nathan C Denham
- Department of Cardiac Electrophysiology and Inherited Cardiac Conditions, Liverpool Heart and Chest Hospital, Liverpool, UK.,Unit of Cardiac Physiology, Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, Core Technology Facility, University of Manchester, Manchester, UK
| | - Robert W Mills
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Wern Y Ding
- Department of Cardiac Electrophysiology and Inherited Cardiac Conditions, Liverpool Heart and Chest Hospital, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Faculty of Life Sciences, University of Liverpool, Liverpool, UK
| | - Simon S Modi
- Department of Cardiac Electrophysiology and Inherited Cardiac Conditions, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Mark C S Hall
- Department of Cardiac Electrophysiology and Inherited Cardiac Conditions, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Derick M Todd
- Department of Cardiac Electrophysiology and Inherited Cardiac Conditions, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Saagar Mahida
- Department of Cardiac Electrophysiology and Inherited Cardiac Conditions, Liverpool Heart and Chest Hospital, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Faculty of Life Sciences, University of Liverpool, Liverpool, UK
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23
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Abstract
A diagnosis of Brugada pattern in paediatric or adolescent patients is rare. COVID-19 is characterised by fevers and a pro-inflammatory state, which may serve as inciting factors for Brugada pattern. Recently described in two adult patients, we report the first case of Brugada pattern in an adolescent with COVID-19.
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Affiliation(s)
- Nak Hyun Choi
- Division of Paediatric Cardiology, Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical Center, New York, New York, USA
| | - Eric S. Silver
- Division of Paediatric Cardiology, Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical Center, New York, New York, USA
| | - Michael Fremed
- Division of Paediatric Cardiology, Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical Center, New York, New York, USA
| | - Leonardo Liberman
- Division of Paediatric Cardiology, Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical Center, New York, New York, USA
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24
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Farooq M, Qureshi F, Kamkoum W, Abuzeyad F. Propafenone and propranolol dual toxicity. J Am Coll Emerg Physicians Open 2020; 1:1104-1107. [PMID: 33145565 PMCID: PMC7593489 DOI: 10.1002/emp2.12126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/07/2022] [Accepted: 05/11/2020] [Indexed: 11/10/2022] Open
Abstract
Propranolol is a highly lipid-soluble beta-receptor antagonist and propafenone is a potent class 1c anti-arrhythmic agent with strong Na-channel blockade effect. We describe a novel case of dual overdose of propafenone and propranolol resulting in hypotension, generalized seizures, and reduced level of consciousness that was successfully treated. A 52-year-old female ingested 500 mg of propranolol and 1.5 g of propafenone. The patient was brought to the emergency department (ED) and exhibited signs of systemic toxicity and reduced level of consciousness. The patient was treated as a case of combined β-blocker and propafenone toxicity using high dose insulin, NaHCO3, glucagon, atropine, and dopamine. She started improving and becoming more alert, with subsequent ECGs revealing normal sinus rhythm. The patient was discharged 4 days later. We believe that early administration of NaHCO3 should be administered in patients exhibiting signs of Na-channel blockade.
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Affiliation(s)
- Moonis Farooq
- Emergency DepartmentKing Hamad University HospitalBusaiteenKingdom of Bahrain
| | - Faisal Qureshi
- Emergency DepartmentKing Hamad University HospitalBusaiteenKingdom of Bahrain
| | - Wael Kamkoum
- Emergency DepartmentKing Hamad University HospitalBusaiteenKingdom of Bahrain
| | - Feras Abuzeyad
- Emergency DepartmentKing Hamad University HospitalBusaiteenKingdom of Bahrain
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Walsh R, Lahrouchi N, Tadros R, Kyndt F, Glinge C, Postema PG, Amin AS, Nannenberg EA, Ware JS, Whiffin N, Mazzarotto F, Škorić-Milosavljević D, Krijger C, Arbelo E, Babuty D, Barajas-Martinez H, Beckmann BM, Bézieau S, Bos JM, Breckpot J, Campuzano O, Castelletti S, Celen C, Clauss S, Corveleyn A, Crotti L, Dagradi F, de Asmundis C, Denjoy I, Dittmann S, Ellinor PT, Ortuño CG, Giustetto C, Gourraud JB, Hazeki D, Horie M, Ishikawa T, Itoh H, Kaneko Y, Kanters JK, Kimoto H, Kotta MC, Krapels IPC, Kurabayashi M, Lazarte J, Leenhardt A, Loeys BL, Lundin C, Makiyama T, Mansourati J, Martins RP, Mazzanti A, Mörner S, Napolitano C, Ohkubo K, Papadakis M, Rudic B, Molina MS, Sacher F, Sahin H, Sarquella-Brugada G, Sebastiano R, Sharma S, Sheppard MN, Shimamoto K, Shoemaker MB, Stallmeyer B, Steinfurt J, Tanaka Y, Tester DJ, Usuda K, van der Zwaag PA, Van Dooren S, Van Laer L, Winbo A, Winkel BG, Yamagata K, Zumhagen S, Volders PGA, Lubitz SA, Antzelevitch C, Platonov PG, Odening KE, Roden DM, Roberts JD, Skinner JR, Tfelt-Hansen J, van den Berg MP, Olesen MS, Lambiase PD, Borggrefe M, Hayashi K, Rydberg A, Nakajima T, Yoshinaga M, Saenen JB, Kääb S, Brugada P, Robyns T, Giachino DF, Ackerman MJ, Brugada R, Brugada J, Gimeno JR, Hasdemir C, Guicheney P, Priori SG, Schulze-Bahr E, Makita N, Schwartz PJ, Shimizu W, Aiba T, Schott JJ, Redon R, Ohno S, Probst V, Behr ER, Barc J, Bezzina CR; Nantes Referral Center for inherited cardiac arrhythmia. Enhancing rare variant interpretation in inherited arrhythmias through quantitative analysis of consortium disease cohorts and population controls. Genet Med 2021; 23:47-58. [PMID: 32893267 DOI: 10.1038/s41436-020-00946-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/03/2020] [Accepted: 08/11/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose Stringent variant interpretation guidelines can lead to high rates of variants of uncertain significance (VUS) for genetically heterogeneous disease like long QT syndrome (LQTS) and Brugada syndrome (BrS). Quantitative and disease-specific customization of American College of Medical Genetics and Genomics/Association for Molecular Pathology (ACMG/AMP) guidelines can address this false negative rate. Methods We compared rare variant frequencies from 1847 LQTS (KCNQ1/KCNH2/SCN5A) and 3335 BrS (SCN5A) cases from the International LQTS/BrS Genetics Consortia to population-specific gnomAD data and developed disease-specific criteria for ACMG/AMP evidence classes—rarity (PM2/BS1 rules) and case enrichment of individual (PS4) and domain-specific (PM1) variants. Results Rare SCN5A variant prevalence differed between European (20.8%) and Japanese (8.9%) BrS patients (p = 5.7 × 10−18) and diagnosis with spontaneous (28.7%) versus induced (15.8%) Brugada type 1 electrocardiogram (ECG) (p = 1.3 × 10−13). Ion channel transmembrane regions and specific N-terminus (KCNH2) and C-terminus (KCNQ1/KCNH2) domains were characterized by high enrichment of case variants and >95% probability of pathogenicity. Applying the customized rules, 17.4% of European BrS and 74.8% of European LQTS cases had (likely) pathogenic variants, compared with estimated diagnostic yields (case excess over gnomAD) of 19.2%/82.1%, reducing VUS prevalence to close to background rare variant frequency. Conclusion Large case–control data sets enable quantitative implementation of ACMG/AMP guidelines and increased sensitivity for inherited arrhythmia genetic testing.
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Lee S, Zhou J, Liu T, Letsas KP, Hothi SS, Vassiliou VS, Li G, Baranchuk A, Sy RW, Chang D, Zhang Q, Tse G. Temporal Variability in Electrocardiographic Indices in Subjects With Brugada Patterns. Front Physiol 2020; 11:953. [PMID: 33013434 PMCID: PMC7494959 DOI: 10.3389/fphys.2020.00953] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/15/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction Patients with Brugada electrocardiographic (ECG) patterns have differing levels of arrhythmic risk. We hypothesized that temporal variations in certain ECG markers may provide additional value for risk stratification. The present study evaluated the relationship between temporal variability of ECG markers and arrhythmic outcomes in patients with a Brugada pattern ECG. Comparisons were made between low-risk asymptomatic subjects versus high-risk symptomatic patients with a history of syncope, ventricular tachycardia (VT) or ventricular fibrillation (VF). Methods A total of 81 patients presenting with Brugada patterns were recruited. Serial ECGs and electronic health records from January 2004 to April 2019 were analyzed. Temporal variability of QRS interval, J point-Tpeak interval (JTp), Tpeak-Tend interval (Tp-e), and ST elevation (STe) in precordial leads V1-3, in addition to RR-interval from lead II, was assessed using standard deviation and difference between maximum and minimum values over the serial ECGs. Results Patients presenting with type 1 Brugada ECG pattern initially had significantly higher variability in JTp from lead V2 (SD: 33.5 ± 13.8 vs. 25.2 ± 11.5 ms, P = 0.009; max-min: 98.6 ± 46.2 vs. 78.3 ± 47.6 ms, P = 0.047) and ST elevation in lead V1 (0.117 ± 0.122 vs. 0.053 ± 0.030 mV; P = 0.004). Significantly higher variability in Tp-e interval measured from lead V3 was observed in the VT/VF group compared to the syncope and asymptomatic groups (SD: 20.5 ± 8.5 vs. 16.6 ± 7.3 and 14.7 ± 9.8 ms; P = 0.044; max-min: 70.2 ± 28.9 vs. 56.3 ± 29.0 and 43.5 ± 28.5 ms; P = 0.011). Conclusion Temporal variability in ECG indices may provide additional value for risk stratification in patients with Brugada pattern.
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Affiliation(s)
- Sharen Lee
- Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Hong Kong, China
| | - Jiandong Zhou
- School of Data Science, City University of Hong Kong, 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
| | - Konstantinos P Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Sandeep S Hothi
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
| | - Vassilios S Vassiliou
- Norwich Medical School, University of East Anglia, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Guoliang Li
- Arrhythmia Unit, Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Adrian Baranchuk
- Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Raymond W Sy
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Dong Chang
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
| | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Hong Kong, 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.,Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
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Nene RV, Tolia VM. Fever-Induced Brugada-Pattern Electrocardiogram. J Emerg Med 2020; 59:432-434. [PMID: 32814676 DOI: 10.1016/j.jemermed.2020.06.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/31/2020] [Accepted: 06/14/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Brugada syndrome is an increasingly recognized syndrome characterized by a particular electrocardiography (ECG) pattern and clinical criteria and has a high incidence of sudden death in patients with structurally normal hearts. The Brugada ECG pattern can be unmasked by drugs, ischemia, and fever. CASE REPORT We present the case of a 47-year-old man who presented to the emergency department with flu-like symptoms and syncope. On arrival, he was febrile and his ECG showed a Brugada pattern. Although this pattern resolved once his fever resolved, the cardiologists were concerned that his syncopal episode might have been due to ventricular tachycardia/fibrillation, and the patient was admitted for implantable cardiac defibrillator placement. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Fever and other stressors can unmask a Brugada pattern on ECG, and if patients have concerning clinical criteria, they should receive emergent cardiology follow-up.
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Affiliation(s)
- Rahul V Nene
- Department of Emergency Medicine, University of California-San Diego, San Diego, California
| | - Vaishal M Tolia
- Department of Emergency Medicine, University of California-San Diego, San Diego, California
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El-Battrawy I, Roterberg G, Schlentrich K, Liebe V, Lang S, Rudic B, Tülümen E, Zhou X, Borggrefe M, Akin I. Clinical Profile and Long-Term Follow-Up of Children with Brugada Syndrome. Pediatr Cardiol 2020; 41:290-6. [PMID: 31748893 DOI: 10.1007/s00246-019-02254-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 11/05/2019] [Indexed: 02/08/2023]
Abstract
Brugada syndrome (BrS) is a rare channelopathy associated with sudden cardiac death (SCD). Although outcome data of adult cohorts are well known, information on children are lacking. The aim of the present study was to analyze the clinical profile, treatment approach and long-term outcome of children affected with BrS. After a systematic review of the literature compiled from a thorough database search (PubMed, Web of Science, Cochrane Libary, Cinahl), data from a total of 4 studies which included 262 BrS patients were identified. The mean age of patients was 12.1 ± 5.5, 53.8% males and 19.8% spontaneous BrS type I. 80.2% of patients presented BrS ECG I after receiving sodium channel blockers. 76% of these patients were asymptomatic while only 17.9% suffered from recurrent syncope. Around 1.5% of the patients were admitted due to aborted SCD, and 3% suffered from atrial arrhythmias. Electrophysiological work-up was performed in 132 patients. Induction of ventricular tachycardia/ventricular fibrillation using programmed ventricular stimulation was inducible in 16 patients. 56 children received an ICD. 11 patients received quinidine. An electrical storm was documented in 1 patient. Appropriate shocks occured in 16% of the patients over a median follow-up period of 62.2 (54-64). ICD-related complications were observed in 11 patients (19.6%) with a predominance of inappropriate shocks and lead failure and/or fracture. Although BrS in the childhood is rare, diagnosis and management continues to be challenging. ICD therapy is an effective therapy in high-risk children with BrS, however, with relevant ICD-related complications.
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Zampi G, Pergolini A, Pontillo D, Sommariva L. A tricky electrocardiogram: cocaine induced Brugada type 2 phenocopy. Am J Cardiovasc Dis 2020; 10:131-135. [PMID: 32685271 PMCID: PMC7364277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/12/2020] [Indexed: 04/14/2023]
Abstract
BACKGROUND The pharmacological effects of cocaine have been associated with different types of cardiac dysrhythmias and with Brugada pattern on the ECG, but currently only type 1 pattern has been described. We report a case of a transient Brugada type 2 pattern in a young cocaine abuser. METHOD We report the clinical presentation of a 32-year-old male with a history of cocaine abuse. RESULT The treatment and the resolution of the acute phase have been described; moreover we discuss the pathophysiology of the Brugada phenocopy in this specificclinical setting. CONCLUSION The clinical impact of our case report underscores the necessity of prompt physician awareness of any ECG abnormality besides myocardial infarction in patients with cocaine abuse, such as any Brugada pattern, which could lead to ominous ventricular arrhythmias.
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Affiliation(s)
- Giordano Zampi
- Department of Cardiology, Belcolle HospitalViterbo, Italy
| | - Amedeo Pergolini
- Department of Cardiovascular Science “S. Camillo-Forlanini” HospitalRome, Italy
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Terrana M, Scavée C. Electrocardiographic changes in STEMI with Brugada syndrome. Acta Cardiol 2019; 74:541-543. [PMID: 30693844 DOI: 10.1080/00015385.2018.1535287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Melina Terrana
- Service de Pathologie Cardiovasculaire, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
| | - Christophe Scavée
- Service de Pathologie Cardiovasculaire, Cliniques Universitaires Saint-Luc, Bruxelles, Belgique
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Roterberg G, El-Battrawy I, Veith M, Liebe V, Ansari U, Lang S, Zhou X, Akin I, Borggrefe M. Arrhythmic events in Brugada syndrome patients induced by fever. Ann Noninvasive Electrocardiol 2019; 25:e12723. [PMID: 31746533 PMCID: PMC7358877 DOI: 10.1111/anec.12723] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/19/2019] [Accepted: 09/22/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The Brugada syndrome is associated with arrhythmic events, which may even lead to sudden cardiac death (SCD) as it causes arrhythmic events. A typical Brugada syndrome ECG type I can be triggered at fever situations. The aim of this pooled meta-analysis is to further explore the baseline characteristics and the association of fever to BrS-related arrhythmic events. METHODS We compiled data from a search of databases (PubMed, Web of Science, Cochrane Library, and Google Scholar). We included 17 studies including 14 case reports and a total of 53 patients. RESULTS Our population including 53 patients showed a male predominance of 92% with a mean age of 40.6 ± 17.7 years. 58% of patients had a family history of SCD or BrS. Genetic screening was performed in 14 patients (26%) and revealed a SCN5A mutation in 21% of the patients. ICD implantation was initiated in six patients. 75% (n = 39) of patients did not have symptoms before the fever event. Symptoms at fever included life-threatening arrhythmia such as ventricular fibrillation (VF) or ventricular tachycardia (VT; 17%), syncope (13%), and cardiac arrest or aborted SCD (13%). One patient developed electrical storm which led to not aborted SCD. CONCLUSION Fever is a great risk factor for arrhythmia events in BrS patients. Patients with known fever triggered Brugada syndrome should be surveilled closely during fever and be started on antipyretic therapy as soon as possible.
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Affiliation(s)
- Gretje Roterberg
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Michael Veith
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Volker Liebe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Uzair Ansari
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Siegfried Lang
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Xiaobo Zhou
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
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El-Battrawy I, Müller J, Zhao Z, Cyganek L, Zhong R, Zhang F, Kleinsorge M, Lan H, Li X, Xu Q, Huang M, Liao Z, Moscu-Gregor A, Albers S, Dinkel H, Lang S, Diecke S, Zimmermann WH, Utikal J, Wieland T, Borggrefe M, Zhou X, Akin I. Studying Brugada Syndrome With an SCN1B Variants in Human-Induced Pluripotent Stem Cell-Derived Cardiomyocytes. Front Cell Dev Biol 2019; 7:261. [PMID: 31737628 PMCID: PMC6839339 DOI: 10.3389/fcell.2019.00261] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 10/17/2019] [Indexed: 01/26/2023] Open
Abstract
Background Among rare channelopathies BrS patients are at high risk of sudden cardiac death (SCD). SCN5A mutations are found in a quarter of patients. Other rare gene mutations including SCN1B have been implicated to BrS. Studying the human cellular phenotype of BrS associated with rare gene mutation remains lacking. Objectives We sought to study the cellular phenotype of BrS with the SCN1B gene variants using human-induced pluripotent stem cell (hiPSCs)–derived cardiomyocytes (hiPSC-CMs). Methods and Results A BrS patient suffering from recurrent syncope harboring a two variants (c.629T > C and c.637C > A) in SCN1B, which encodes the function-modifying sodium channel beta1 subunit, and three independent healthy subjects were recruited and their skin biopsies were used to generate hiPSCs, which were differentiated into cardiomyocytes (hiPSC-CMs) for studying the cellular electrophysiology. A significantly reduced peak and late sodium channel current (INa) and a shift of activation curve to more positive potential as well as a shift of inactivation curve to more negative potential were detected in hiPSC-CMs of the BrS patient, indicating that the SCN1B variants impact the function of sodium channels in cardiomyocytes. The reduced INa led to a reduction of amplitude (APA) and upstroke velocity (Vmax) of action potentials. Ajmaline, a sodium channel blocker, showed a stronger effect on APA and Vmax in BrS cells as compared to cells from healthy donors. Furthermore, carbachol was able to increase arrhythmia events and the beating frequency in BrS. Conclusion Our hiPSC-CMs from a BrS-patient with two variants in SCN1B recapitulated some key phenotypic features of BrS and can provide a platform for studies on BrS with SCN1B variants.
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Affiliation(s)
- Ibrahim El-Battrawy
- First Department of Medicine, University Medical Centre Mannheim (UMM), Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Sites Heidelberg-Mannheim and Göttingen, Mannheim, Germany
| | - Jonas Müller
- First Department of Medicine, University Medical Centre Mannheim (UMM), Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Sites Heidelberg-Mannheim and Göttingen, Mannheim, Germany
| | - Zhihan Zhao
- First Department of Medicine, University Medical Centre Mannheim (UMM), Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Sites Heidelberg-Mannheim and Göttingen, Mannheim, Germany
| | - Lukas Cyganek
- DZHK (German Center for Cardiovascular Research), Partner Sites Heidelberg-Mannheim and Göttingen, Mannheim, Germany.,Stem Cell Unit, Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Rujia Zhong
- First Department of Medicine, University Medical Centre Mannheim (UMM), Mannheim, Germany
| | - Feng Zhang
- First Department of Medicine, University Medical Centre Mannheim (UMM), Mannheim, Germany
| | - Mandy Kleinsorge
- DZHK (German Center for Cardiovascular Research), Partner Sites Heidelberg-Mannheim and Göttingen, Mannheim, Germany.,Stem Cell Unit, Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Huan Lan
- First Department of Medicine, University Medical Centre Mannheim (UMM), Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Sites Heidelberg-Mannheim and Göttingen, Mannheim, Germany.,Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological, Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
| | - Xin Li
- First Department of Medicine, University Medical Centre Mannheim (UMM), Mannheim, Germany
| | - Qiang Xu
- First Department of Medicine, University Medical Centre Mannheim (UMM), Mannheim, Germany
| | - Mengying Huang
- First Department of Medicine, University Medical Centre Mannheim (UMM), Mannheim, Germany
| | - Zhenxing Liao
- First Department of Medicine, University Medical Centre Mannheim (UMM), Mannheim, Germany
| | | | - Sebastian Albers
- First Department of Medicine, University Medical Centre Mannheim (UMM), Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Sites Heidelberg-Mannheim and Göttingen, Mannheim, Germany
| | - Hendrik Dinkel
- First Department of Medicine, University Medical Centre Mannheim (UMM), Mannheim, Germany
| | - Siegfried Lang
- First Department of Medicine, University Medical Centre Mannheim (UMM), Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Sites Heidelberg-Mannheim and Göttingen, Mannheim, Germany
| | | | - Wolfram-Hubertus Zimmermann
- DZHK (German Center for Cardiovascular Research), Partner Sites Heidelberg-Mannheim and Göttingen, Mannheim, Germany.,Institute of Pharmacology and Toxicology, University of Göttingen, Göttingen, Germany
| | - Jochen Utikal
- DZHK (German Center for Cardiovascular Research), Partner Sites Heidelberg-Mannheim and Göttingen, Mannheim, Germany.,Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg and Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Thomas Wieland
- DZHK (German Center for Cardiovascular Research), Partner Sites Heidelberg-Mannheim and Göttingen, Mannheim, Germany.,Institute of Experimental and Clinical Pharmacology and Toxicology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Centre Mannheim (UMM), Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Sites Heidelberg-Mannheim and Göttingen, Mannheim, Germany
| | - Xiaobo Zhou
- First Department of Medicine, University Medical Centre Mannheim (UMM), Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Sites Heidelberg-Mannheim and Göttingen, Mannheim, Germany.,Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological, Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim (UMM), Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Sites Heidelberg-Mannheim and Göttingen, Mannheim, Germany
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Marschall C, Moscu-Gregor A, Klein HG. Variant panorama in 1,385 index patients and sensitivity of expanded next-generation sequencing panels in arrhythmogenic disorders. Cardiovasc Diagn Ther 2019; 9:S292-S298. [PMID: 31737537 DOI: 10.21037/cdt.2019.06.06] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Arrhythmogenic disorders occur in a broad spectrum of cardiac pathologies in the general population with a prevalence of 1:10,000 to 1:500. Genetic studies conducted during the past 20 years have markedly illuminated the genetic basis of inherited cardiac disorders. However, uncertainty exists regarding which genes should be included and routinely assessed on genetic testing panels. Here, we review the genetic basis of the most important arrhythmogenic disorders found in our laboratory since 2016 by next-generation sequencing (NGS) analysis. Methods We analyzed sequence data from 1,385 clinical index cases with a suspected diagnosis of long QT syndrome (LQTS), Brugada syndrome (BrS), catecholaminergic polymorphic ventricular tachycardia (CPVT), hypertrophic cardiomyopathy (HCM), dilatative cardiomyopathy (DCM) or arrhythmogenic right ventricular cardiomyopathy (ARVC). Genetic testing was performed by NGS using a custom design based on an Agilent SureSelectQXT. Results The detection rate of pathogenic or likely pathogenic variants was in the range of 16% for BrS to 40% for HCM. Only the few well known core genes and some additional side genes substantially contribute to the diagnostic sensitivity. Conclusions Clinical testing provides a definitive diagnosis for many patients. The genetic result may be important for risk stratification, genetic counseling and, in some cases, treatment planning. Diagnostic panels should not be further expanded as inclusion of many genes rather produces variants of unclear significance and confusing reports.
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Affiliation(s)
| | | | - Hanns-Georg Klein
- Center for Human Genetics and Laboratory Diagnostics, Martinsried, Germany
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El-Battrawy I, Roterberg G, Liebe V, Ansari U, Lang S, Zhou X, Borggrefe M, Akin I. Implantable cardioverter-defibrillator in Brugada syndrome: Long-term follow-up. Clin Cardiol 2019; 42:958-965. [PMID: 31441080 PMCID: PMC6788474 DOI: 10.1002/clc.23247] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/01/2019] [Accepted: 08/07/2019] [Indexed: 11/09/2022] Open
Abstract
Background Brugada syndrome (BrS) is associated with sudden cardiac death (SCD). Although implantable cardioverter‐defibrillator (ICD) implantation is recommended, the long‐term outcomes and follow‐up data with regard to ICD complications have led to controversy. Hypothesis In the present study, we described the data assimilated in a total of 11 studies, analyzing the outcome in 747 BrS patients receiving ICD. Methods Data were performed and analyzed after a systematic review of literature compiled from a thorough database search (PubMed, Web of Science, Cochrane Library, and Cinahl). Results The mean age of patients receiving ICD was (43.1 ± 13.4, 82.5% males, 46.6% spontaneous BrS type I). Around 15.3% of the patients were admitted due to SCD and 10.4% suffered from atrial arrhythmia. Appropriate shocks were documented in 18.1% of the patients over a mean follow‐up period of 82.3 months (47.5‐110.4). The following complications were recorded: lead failure and fracture (5.4%), lead perforation (0.7%), lead dislodgement (1.7%), infection (3.9%), pain (0.4%), subclavian vein thrombosis (0.3%), pericardial effusion (0.1%), endocarditis (0.1%), psychiatric problems (1.5%), pneumothorax (0.7%). Inappropriate shocks were documented in 18.1% of the patients. The management of inappropriate shocks was achieved by pulmonary vein isolation (0.5%), drug treatment with sotalol (1.3%) or sotalol with beta‐blocker (0.3%) and hydroquinidine (0.1%). Conclusions ICD therapy in BrS is associated with relevant ICD‐related complications including a substantial risk of inappropriate shocks more frequently in symptomatic BrS patients.
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Affiliation(s)
- Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Mannheim, Germany
| | - Gretje Roterberg
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Volker Liebe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Uzair Ansari
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Siegfried Lang
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Mannheim, Germany
| | - Xiaobo Zhou
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Mannheim, Germany
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35
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Alhaj EK, Banning M, Vasaiwala SC, Santucci PA. Wolff-Parkinson-White, Brugada phenocopy, and flecainide toxicity: All in one patient. Clin Case Rep 2019; 7:1098-1102. [PMID: 31110754 PMCID: PMC6509998 DOI: 10.1002/ccr3.2156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 03/23/2019] [Accepted: 03/27/2019] [Indexed: 11/24/2022] Open
Abstract
Accessory pathway Wolff-Parkinson-white is sometimes not manifested till later in life, as the conduction properties of AV node become slower, other mechanisms are also possible. Brugada pattern on EKG can be associated with various underlying clinical conditions, such as mechanical compression of RVOT by tumors. It is essential to have high index of suspicion for flecainide toxicity when encountering arrhythmias in patients taking the drug.
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Affiliation(s)
- Eyad K. Alhaj
- Division of Cardiology/ElectrophysiologyLoyola University Medical CenterMaywoodIllinois
| | - Michael Banning
- Division of Cardiology/ElectrophysiologyLoyola University Medical CenterMaywoodIllinois
| | - Smit C. Vasaiwala
- Division of Cardiology/ElectrophysiologyLoyola University Medical CenterMaywoodIllinois
| | - Peter A. Santucci
- Division of Cardiology/ElectrophysiologyLoyola University Medical CenterMaywoodIllinois
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Eveson LJ, Cox AT, Dhutia H, Ensem B, Behr E, Sharma S. Getting to the heart of the matter: investigating the idiopathic sudden cardiac death of a previous well soldier. J ROY ARMY MED CORPS 2019; 165:377-379. [PMID: 30886006 DOI: 10.1136/jramc-2018-001103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 11/03/2022]
Abstract
A 25-year-old infantry soldier, who was previously fit and well, had a cardiac arrest while undertaking an advanced fitness test. Despite early cardiopulmonary resuscitation by colleagues and the emergency services, he was later pronounced dead. A postmortem performed by an expert pathologist and a toxicology screen were normal and the death was attributed to sudden arrhythmic death syndrome (SADS). Screening of his family in our Inherited Cardiac Conditions clinic identified Brugada syndrome (BrS) in two first-degree relatives. This case generates discussion on sudden cardiac death, family screening in SADS, BrS and the limitations of recruit screening with an ECG.
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Affiliation(s)
- Leanne Jane Eveson
- Royal Centre Defence Medicine, Defence Medical Services, Lichfield, UK .,Cardiology, Royal Brompton Hospital, London, UK
| | - A T Cox
- Royal Centre Defence Medicine, Defence Medical Services, Lichfield, UK.,St George's University of London, London, UK
| | - H Dhutia
- St George's University of London, London, UK
| | - B Ensem
- St George's University of London, London, UK
| | - E Behr
- Cardiology, 3. St George's, University of London, London, UK
| | - S Sharma
- St George's University of London, London, UK
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37
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Rojas SF, Oglat A, Bonilla HMG, Jeroudi O, Sharp W, Valderrábano M, Schurmann PA. Loperamide Mimicking Brugada Pattern. Methodist Debakey Cardiovasc J 2019; 14:e1-e3. [PMID: 30788023 DOI: 10.14797/mdcj-14-4-e1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Brugada syndrome is an inherited arrhythmia that increases a patient's risk of sudden cardiac death. Certain pharmacologic agents may induce a transient Brugada pattern on surface electrocardiogram (EKG). One of these is loperamide, an over-the-counter agent commonly used to manage diarrhea. We report the case of a patient who experienced EKG changes that mimicked Brugada pattern after excessive intake of loperamide.
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Affiliation(s)
| | - Ayah Oglat
- HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | | | - Omar Jeroudi
- HOUSTON METHODIST DEBAKEY HEART AND VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | | | - Miguel Valderrábano
- HOUSTON METHODIST DEBAKEY HEART AND VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Paul Antonio Schurmann
- HOUSTON METHODIST DEBAKEY HEART AND VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
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38
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Denham NC, Pearman CM, Ding WY, Waktare J, Gupta D, Snowdon R, Hall M, Cooper R, Modi S, Todd D, Mahida S. Systematic re-evaluation of SCN5A variants associated with Brugada syndrome. J Cardiovasc Electrophysiol 2018; 30:118-127. [PMID: 30203441 DOI: 10.1111/jce.13740] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/01/2018] [Accepted: 09/07/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND A large number of SCN5A variants have been reported to underlie Brugada syndrome (BrS). However, the evidence supporting individual variants is highly heterogeneous. OBJECTIVE We systematically re-evaluated all SCN5A variants reported in BrS using the 2015 American college of medical genetics and genomics and the association for molecular pathology (ACMG-AMP) guidelines. METHODS A PubMed/Embase search was performed to identify all reported SCN5A variants in BrS. Standardized bioinformatic re-analysis (SIFT, PolyPhen, Mutation Taster, Mutation assessor, FATHMM, GERP, PhyloP, and SiPhy) and re-evaluation of frequency in the gnomAD database were performed. Fourteen ACMG-AMP rules were deemed applicable for SCN5A variant analysis. RESULTS Four hundred and eighty unique SCN5A variants were identified, the majority of which 425 (88%) were coding variants. One hundred and fifty-six of 425 (37%) variants were classified as pathogenic/likely pathogenic. Two hundred and fifty-eight (60%) were classified as variants of uncertain significance, while a further 11 (3%) were classified as benign/likely benign. When considering the subset of variants that were considered "null" variants separately, 95% fulfilled criteria for pathogenicity/likely pathogenicity. In contrast, only 17% of missense variants fulfilled criteria for pathogenicity/likely pathogenicity. Importantly, however, only 25% of missense variants had available functional data, which was a major score driver for pathogenic classification. CONCLUSION Based on contemporary ACMG-AMP guidelines, only a minority of SCN5A variants implicated in BrS fulfill the criteria for pathogenicity or likely pathogenicity.
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Affiliation(s)
- Nathan C Denham
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Inherited Cardiac Diseases, Liverpool Heart and Chest Hospital, Liverpool, UK.,Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Charles M Pearman
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Inherited Cardiac Diseases, Liverpool Heart and Chest Hospital, Liverpool, UK.,Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Wern Yew Ding
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Johan Waktare
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Dhiraj Gupta
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Richard Snowdon
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Inherited Cardiac Diseases, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Mark Hall
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Robert Cooper
- Department of Inherited Cardiac Diseases, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Simon Modi
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Inherited Cardiac Diseases, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Derick Todd
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Inherited Cardiac Diseases, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Saagar Mahida
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Inherited Cardiac Diseases, Liverpool Heart and Chest Hospital, Liverpool, UK
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Amara W, Feki A, Monsel F. [Asymptomatic Brugada syndrome: From diagnosis to treatment]. Ann Cardiol Angeiol (Paris) 2017; 66:295-298. [PMID: 29050740 DOI: 10.1016/j.ancard.2017.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/19/2017] [Indexed: 06/07/2023]
Abstract
Brugada syndrome management may be a difficult question. This article reviews diagnosis, prognosis evaluation, current and investigated treatments.
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Affiliation(s)
- W Amara
- Unité de rythmologie, GHI Le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France.
| | - A Feki
- Unité de rythmologie, GHI Le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
| | - F Monsel
- Unité de rythmologie, GHI Le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
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40
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Abstract
TRPM4 forms a non-selective cation channel activated by internal Ca(2+). Its functional expression was demonstrated in cardiomyocytes of several mammalian species including humans, but the channel is also present in many other tissues. The recent characterization of the TRPM4 inhibitor 9-phenanthrol, and the availability of transgenic mice have helped to clarify the role of TRPM4 in cardiac electrical activity, including diastolic depolarization from the sino-atrial node cells in mouse, rat, and rabbit, as well as action potential duration in mouse cardiomyocytes. In rat and mouse, pharmacological inhibition of TRPM4 prevents cardiac ischaemia-reperfusion injuries and decreases the occurrence of arrhythmias. Several studies have identified TRPM4 mutations in patients with inherited cardiac diseases including conduction blocks and Brugada syndrome. This review identifies TRPM4 as a significant actor in cardiac electrophysiology.
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Affiliation(s)
- Romain Guinamard
- Groupe Signalisation, Electrophysiologie et Imagerie des Lésions d'Ischémie-Reperfusion Myocardique, EA4650, Université de Caen Basse-Normandie, Sciences D, Esplanade de la Paix, CS 14032, 14032 Caen Cedex 5, France
| | | | - Thomas Hof
- Groupe Signalisation, Electrophysiologie et Imagerie des Lésions d'Ischémie-Reperfusion Myocardique, EA4650, Université de Caen Basse-Normandie, Sciences D, Esplanade de la Paix, CS 14032, 14032 Caen Cedex 5, France
| | - Hui Liu
- Department of Anatomy, Hainan Medical College, Haikou, Hainan 571101, China
| | - Christophe Simard
- Groupe Signalisation, Electrophysiologie et Imagerie des Lésions d'Ischémie-Reperfusion Myocardique, EA4650, Université de Caen Basse-Normandie, Sciences D, Esplanade de la Paix, CS 14032, 14032 Caen Cedex 5, France
| | - Laurent Sallé
- Groupe Signalisation, Electrophysiologie et Imagerie des Lésions d'Ischémie-Reperfusion Myocardique, EA4650, Université de Caen Basse-Normandie, Sciences D, Esplanade de la Paix, CS 14032, 14032 Caen Cedex 5, France
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Makarawate P, Chaosuwannakit N, Ruamcharoen Y, Panthongviriyakul A, Pongchaiyakul C, Tharaksa P, Sripo T, Sawanyawisuth K. Prevalence and associated factors of early repolarization pattern in healthy young northeastern Thai men: A correlation study with Brugada electrocardiography. J Arrhythm 2015; 31:215-20. [PMID: 26336562 DOI: 10.1016/j.joa.2014.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 12/10/2014] [Accepted: 12/16/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Early repolarization pattern (ERP) is characterized by J-point elevation with QRS notching or slurring in the terminal portion of the QRS complex. It may be associated with sudden death. Brugada syndrome (BS) is a genetic and fatal disease commonly found in northeastern Thai men. Data on the rate and predictors of ERP in Asian populations are limited. In addition, the correlation between ERP and BS has never been studied in an endemic area of BS. This study aimed to evaluate the prevalence of ERP and its associated factors in young, healthy male Asian subjects. METHODS Between June 2011 and May 2012, 282 young, healthy men aged 20-45 years were enrolled at check-up clinics in Khon Kaen, Thailand. Subjects were divided into the ERP and non-ERP groups. RESULTS There were 29 subjects with ERP (10.3%). The Sokolow-Lyon index was an independent factor for ERP with an adjusted odds ratio of 1.090 (95% CI: 1.027, 1.159). The Brugada ECG pattern was found in 11 (37.9%) subjects in the ERP group. The Brugada ECG pattern (non-type 1) was commonly found in lateral ERP patients. After the placement of high intercostal leads, the Brugada ECG pattern was dramatically increased compared with results obtained during standard ECG lead placement. CONCLUSIONS The ERP rate in young, healthy men from northeastern Thailand was 10.3%. A higher Sokolow-Lyon index was the only independent factor associated with ERP. Subjects with ERP should be examined with high intercostal leads to uncover Brugada ECG.
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Affiliation(s)
- Pattarapong Makarawate
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Narumol Chaosuwannakit
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Yossavadee Ruamcharoen
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Aunejit Panthongviriyakul
- Electrocardiography and Echocardiogram Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Choowong Pongchaiyakul
- Electrocardiography and Echocardiogram Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Prapapan Tharaksa
- Electrocardiography and Echocardiogram Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Temsiri Sripo
- Electrocardiography and Echocardiogram Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Kittisak Sawanyawisuth
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand ; Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen 40002, Thailand
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Rasmussen PV, Nielsen JB, Pietersen A, Graff C, Lind B, Struijk JJ, Olesen MS, Haunsø S, Køber L, Svendsen JH, Holst AG. Electrocardiographic precordial ST-segment deviations and the risk of cardiovascular death: results from the Copenhagen ECG Study. J Am Heart Assoc 2014; 3:e000549. [PMID: 24815495 PMCID: PMC4309043 DOI: 10.1161/jaha.113.000549] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background We sought to perform a study assessing the association between electrocardiographic
ST‐segment deviations and cardiovascular death (CVD), in relation to sex and age (≥
and <65 years), in a large primary care population without overt ischemic heart disease. Methods and Results Using computerized analysis of ECGs from 285 194 persons, we evaluated the association between
precordial ST‐segment deviations and the risk of CVD. All data on medication, comorbidity,
and outcomes were retrieved from Danish registries. After a median follow‐up period of 5.8
years, there were 6679 cardiovascular deaths. Increasing ST‐depression was associated with an
increased risk of CVD in almost all of the precordial leads, with the most robust association seen
in lead V5 to V6. ST‐elevations in lead V2 to V6 were associated with increased risk of CVD
in young women, but not in men. However, ST‐elevations in V1 increased the risk for both
genders and age groups, exemplified by a HR of 1.80 (95% CI [1.19 to 2.74],
P=0.005) for men <65 years with ST‐elevations ≥150
μV versus a nondeviating ST‐segment (−50 μV to +50 μV). In
contrast, for men <65 years, ST‐elevations in lead V2 to V3 conferred a decreased risk
of CVD with a HR of 0.77 (95% CI [0.62 to 0.96], P<0.001) for
ST‐elevations ≥150 μV in V2. Conclusion We found that ST‐depressions were associated with a dose‐responsive increased risk
of CVD in nearly all the precordial leads. ST‐elevations conferred an increased risk of CVD
in women and with regard to lead V1 also in men. However, ST‐elevations in V2 to V3 were
associated with a decreased risk of CVD in young men.
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Abstract
Cardiovascular-related sudden death is the leading cause of mortality in athletes during sport. Thus, it is of clinical importance to identify ECG changes that represent normal adaptation in athletes, and differentiate them from truly pathological findings. However, a distinction between adaptive and pathological ECG changes in athletes is not always easy. This article discusses exercise-induced ECG changes and the differential diagnosis of conditions that present with similar ECG patterns.
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Muller ML. Dysrhythmia in infancy: common diagnosis or obscure genetic syndrome? J Pediatr Health Care 2013; 27:385-9. [PMID: 23267725 DOI: 10.1016/j.pedhc.2012.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 10/07/2012] [Accepted: 10/10/2012] [Indexed: 11/22/2022]
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Boukens BJ, Sylva M, de Gier-de Vries C, Remme CA, Bezzina CR, Christoffels VM, Coronel R. Reduced sodium channel function unmasks residual embryonic slow conduction in the adult right ventricular outflow tract. Circ Res 2013; 113:137-41. [PMID: 23661717 DOI: 10.1161/circresaha.113.301565] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
RATIONALE In patients with Brugada syndrome, arrhythmias typically originate in the right ventricular outflow tract (RVOT). The RVOT develops from the slowly conducting embryonic outflow tract. OBJECTIVE We hypothesize that this embryonic phenotype is maintained in the fetal and adult RVOT and leads to conduction slowing, especially after sodium current reduction. METHODS AND RESULTS We determined expression patterns in the embryonic myocardium and performed activation mapping in fetal and adult hearts, including hearts from adult mice heterozygous for a mutation associated with Brugada syndrome (Scn5a1798insD/+). The embryonic RVOT was characterized by expression of Tbx2, a repressor of differentiation, and absence of expression of both Hey2, a ventricular transcription factor, and Gja1, encoding the principal gap-junction subunit for ventricular fast conduction. Also, conduction velocity was lower in the RVOT than in the right ventricular free wall. Later in the development, Gja1 and Scn5a expression remained lower in the subepicardial myocardium of the RVOT than in RV myocardium. Nevertheless, conduction velocity in the adult RVOT was similar to that of the right ventricular free wall. However, in hearts of Scn5a1798insD/+ mice and in normal hearts treated with ajmaline, conduction was slower in the RVOT than in the right ventricular wall. CONCLUSIONS The slowly conducting embryonic phenotype is maintained in the fetal and adult RVOT and is unmasked when cardiac sodium channel function is reduced.
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Affiliation(s)
- Bas J Boukens
- Department of Anatomy, Embryology, and Physiology, Academic Medical Center, Amsterdam, The Netherlands
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46
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Moltedo JM, Abello M, Gustavo S, Javier C, Delucis PG. Epicardial automatic implantable cardiac defibrillator in a child with symptomatic bugada syndrome. Indian Pacing Electrophysiol J 2011; 11:126-8. [PMID: 21760684 PMCID: PMC3128819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
An 18 month old 14 kg male with symptomatic Brugada syndrome underwent placement of an epicardial automatic implantable cardiac defibrillator using a single coil transvenous lead sutured to the anterolateral aspect of the left ventricle.
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Affiliation(s)
- Jose M Moltedo
- Electrophysiology Section, FLENI, Buenos Aires, Argentina
| | | | - Sivori Gustavo
- Section of Pediatric Cardiovascular Surgery, FLENI, Buenos Aires, Argentina
| | - Celada Javier
- Section of Pediatric Cardiovascular Surgery, FLENI, Buenos Aires, Argentina
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