Insight into specific pro-arrhythmic triggers in Brugada and early repolarization syndromes: results of long-term follow-up.
Insight into specific pro-arrhythmic triggers in Brugada and early repolarization syndromes: results of long-term follow-up.
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深入了解 Brugada 和早期复极综合征的特定促心律失常触发因素：长期随访结果。
DOI：
10.1007/s00380-016-0828-8
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发表时间：
2016
期刊：
影响因子：
1.5
通讯作者：
Hasebe N.
中科院分区：
文献类型：
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作者：
Talib AK;Sato N;Myojo T;Sugiyama E;Nakagawa N;Sakamoto N;Tanabe Y;Fujino T;Takeuchi T;Akasaka K;Matsuhashi H;Saijo Y;Kawamura Y;Doi A;Hasebe N.
除病例报告外，尚未对Brugada和早期复极综合征（BrS，ERS）的促心律失常触发因素进行系统分析。我们在临床上调查了长期随访期间这些综合征中发生糖尿病事件的先兆/易感因素。采集患者/目击者的详细病史，以调查晕厥/室颤（VF）前几个小时内的前驱事件;审查急诊室（ER）的病历、ECG和血液检查。19例符合研究标准的患者随访71 ± 49个月（34-190个月）。事件（晕厥/VF）发生前，患者按以下降序进行不同的活动;饮用酒精饮料、吃饭、从睡眠中起床、锻炼。3例患者在事件发生前报告了精神/身体压力，2例患者在开始口服类固醇治疗支气管哮喘后数天发生VF。在ER中，发现J波振幅升高（0.27 ± 0.15 mV），58%的患者存在低钾血症。纠正电解质和停用激素后，第二天血浆K+（4.2 ± 0.3mEq/L，P< 0.001）显著升高，J波振幅（0.13 ± 0.1mV，P< 0.001）显著降低。3名患者继续口服螺内酯/钾补充剂。随访71 ± 49（34-190）个月，4例VF复发患者中，1例口服类固醇后发生VF。在ERS和BrS中，低钾血症和皮质类固醇治疗增加了显著的促肾上腺皮质激素作用，但可能是可治疗的。停止类固醇治疗和避免低钾血症具有良好的长期结局。
The pro-arrhythmic triggers in Brugada and early repolarization syndromes (BrS, ERS) have not been analyzed systematically except for case reports. We clinically investigated the circumstances which precede/predispose to arrhythmic events in these syndromes during long-term follow-up. A detailed history from the patients/witnesses was taken to investigate the antecedent events in the last few hours that preceded syncope/ventricular fibrillation (VF); medical records, ECG and blood test from the emergency room (ER) were reviewed. 19 patients that fulfilled the investigation criteria were followed up for 71 ± 49 months (34–190 months). Prior to the event (syncope/VF), the patients were partaking different activities in the following decreasing order; drinking alcoholic beverage, having meal, and getting up from sleep, exercise. 3 patients reported mental/physical stress prior to the event and 2 patients developed VF several days after starting oral steroid for treatment of bronchial asthma. In the ER, elevated J-wave amplitude (0.27 ± 0.15 mV) was found with 58 % of the patients having hypokalemia. After electrolyte correction and cessation of steroids, the following day plasma K+(4.2 ± 0.3 mEq/L,P< 0.001) was significantly increased and J-wave amplitude (0.13 ± 0.1 mV,P< 0.001) was remarkably reduced. Three patients were kept on oral spironolactone/potassium supplements. During follow-up for 71 ± 49 (34–190) months, among 4 patients with VF recurrence, one patient developed VF after taking oral steroid. In ERS and BrS, hypokalemia and corticosteroid therapy add substantial pro-arrhythmic effects, but potentially treatable. Stopping steroid therapy and avoiding hypokalemia had excellent long-term outcome.