Indication and prognostic significance of programmed ventricular stimulation in asymptomatic patients with Brugada syndrome
Indication and prognostic significance of programmed ventricular stimulation in asymptomatic patients with Brugada syndrome
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DOI：
10.1093/europace/euaa003
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发表时间：
2020-06-01
期刊：
影响因子：
6.1
通讯作者：
Ito, Hiroshi
中科院分区：
文献类型：
--
作者：
Asada, Saori;Morita, Hiroshi;Ito, Hiroshi
目的探讨程序心室刺激（PVS）治疗无症状Brugada综合征（BrS）患者的适应证，并根据心电图（ECG）异常指标评价PVS的预后意义。我们在右心室的两个部位进行了PVS，最多有三次额外刺激[两个起搏周期长度和180 ms的最小耦合间期（MCI）]。我们对患者进行了133个月的随访，并评估了室颤（VF）事件。碎片化QRS（fQRS）和Tpeak-Tend（Tpe）间期被评估为识别高风险患者的心电图标志物。在66例和37例患者中分别观察到碎裂QRS和长Tpe间期（>= 100 ms）。60例PVS诱发室颤。随访期间，10例患者发生VF事件。碎裂QRS、长Tpe间期和室性早搏诱发的室颤MCI> 180 ms或最多2次额外刺激与未来室颤事件相关（fQRS：P = 0.015，Tpe >= 100 ms：P = 0.038，室颤诱发：P < 0.001）。然而，MCI为200 ms的PVS诱导VF的特异性较低（P = 0.049）。随访期间无ECG标记的室性快速性心律失常事件的频率为0%/年，无VF诱导的为0.1%/年。两个诱发VF的ECG因素的存在与将来的VF事件密切相关（事件发生率：4.4%/年，P < 0.001），并且一个ECG因素的存在与诱发VF也相关（事件发生率：1.3%/年，结论我们建议对有fQRS和/或长Tpe间期的无症状患者采用严格的PVS方案，以识别高危患者。
Aims To establish the indication for programmed ventricular stimulation (PVS) for asymptomatic patients with Brugada syndrome (BrS), we evaluated the prognostic significance of PVS based on abnormal electrocardiogram (ECG) markers.Methods and results One hundred and twenty-five asymptomatic patients with BrS were included. We performed PVS at two sites of the right ventricle with up to three extrastimuli [two pacing cycle lengths and minimum coupling interval (MCI) of 180 ms]. We followed the patients for 133 months and evaluated ventricular fibrillation (VF) events. Fragmented QRS (fQRS) and Tpeak-Tend (Tpe) interval were evaluated as ECG markers for identifying high-risk patients. Fragmented QRS and long Tpe interval (>= 100 ms) were observed in 66 and 37 patients, respectively. Ventricular fibrillation was induced by PVS in 60 patients. During follow-up, 10 patients experienced VF events. Fragmented QRS, long Tpe interval, and PVS-induced VF with an MCI of 180 ms or up to two extrastimuli were associated with future VF events (fQRS: P = 0.015, Tpe >= 100 ms: P = 0.038, VF induction: P < 0.001). However, PVS-induced VF with an MCI of 200 ms was less specific (P = 0.049). The frequencies of ventricular tachyarrhythmia events during follow-up were 0%/year with no ECG markers and 0.1%/year with no VF induction. The existence of two ECG factors with induced VF was strongly associated with future VF events (event rate: 4.4%/year, P < 0.001), and the existence of one ECG factor with induced VF was also associated (event rate: 1.3%/year, P = 0.011).Conclusion We propose PVS with a strict protocol for asymptomatic patients with fQRS and/or long Tpe interval to identify high-risk patients.