Coexistence of atrioventricular accessory pathways and drug-induced type 1 Brugada pattern.
Coexistence of atrioventricular accessory pathways and drug-induced type 1 Brugada pattern.
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DOI：
10.1111/pace.13414
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发表时间：
2018-09
期刊：
影响因子：
--
通讯作者：
Antzelevitch C
中科院分区：
文献类型：
--
作者：
Hasdemir C;Juang JJ;Kose S;Kocabas U;Orman MN;Payzin S;Sahin H;Celen C;Ozcan EE;Chen CJ;Gunduz R;Turan OE;Senol O;Burashnikov E;Antzelevitch C
房性心律失常，特别是房室结折返性心动过速，可与药物诱导的1型Brugada心电图(DI-Type1-BRP)共存。本研究旨在了解房室旁路(AV-AP)患者DI型BRP的患病率，并对其临床、心电图、电生理和遗传学特征进行研究。连续124例房性心动过速患者和84例对照组接受了阿吉马林激发试验，以揭示DI-1-BRP。对55例患者进行了基因筛查和分析(19例合并DI型BRP，36例不合并DI型BRP)。与对照组相比，房室旁路综合征患者发生1型BRP的可能性显著增加(16.1%对4.8%，p=0.012)。与非DI型房室折返性心动过速(AVRT)患者相比，DI型房室折返性心动过速(AVRT)患者预激时胸痛、V1 QR/RSR‘型、V2和aVL QRS切迹/浊音、V1-V2 RSR’型和aVL QRS切迹/浊音的发生率高于非DI型房室折返性心动过速患者。所有DI型BRP患者在预激期间均出现异常的QRS构型(QRS切迹/混浊和/或碎裂)。DI型房颤患者和无DI型房颤患者的自发预激心房颤动发生率和房颤病史相似(分别为15%和18.3%，P=0.726)。DI-Type1-BRP患者Brugada易感基因突变的发生率高于非DI-Type1-BRP患者(36.8%比8.3%，p=0.02)。Di-Type1-BRP在房室旁道患者中相对常见。我们发现预激和顺序性AVRT期间的12导联心电图特征指向潜在的1型-BRP，预示着恶性心律失常发生的可能性增加。
Atrial arrhythmias, particularly atrioventricular nodal reentrant tachycardia, can coexist with drug-induced type 1 Brugada ECG pattern (DI-Type1-BrP). The present study was designed to determine the prevalence of DI-Type1-BrP in patients with atrioventricular accessory pathways (AV-APs) and to investigate the clinical, electrocardiographic, electrophysiologic and genetic characteristics of these patients. One-hundred-twenty-four consecutive cases of AV-APs and 84 controls underwent an ajmaline challenge test to unmask DI-Type1-BrP. Genetic screening and analysis was performed in 55 of the cases (19 with and 36 without DI-Type1-BrP). Patients with AV-APs were significantly more likely than controls to have a Type1-BrP unmasked (16.1 versus 4.8%, p=0.012). At baseline, patients with DI-Type1-BrP had higher prevalence of chest pain, QR/rSr′ pattern in V1 and QRS notching/slurring in V2 and aVL during pre-excitation, rSr′ pattern in V1-V2 and QRS notching/slurring in aVL during orthodromic atrioventricular reentrant tachycardia (AVRT) compared to patients without DI-Type1-BrP. Abnormal QRS configuration (QRS notching/slurring and/or fragmentation) in V2 during pre-excitation was present in all patients with DI-Type1 BrP. The prevalence of spontaneous pre-excited atrial fibrillation (AF) and history of AF were similar (15% versus 18.3%, p=0.726) in patients with and without DI-Type1-BrP, respectively. The prevalence of mutations in Brugada-susceptibility genes was higher (36.8% versus 8.3%, p=0.02) in patients with DI-Type1-BrP compared to patients without DI-Type1-BrP. DI-Type1-BrP is relatively common in patients with AV-APs. We identify 12-lead ECG characteristics during pre-excitation and orthodromic AVRT that point to an underlying type1-BrP, portending an increased probability for development of malignant arrhythmias.
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