Long-term prognosis of individuals with right precordial ST-segment-elevation Brugada syndrome
Long-term prognosis of individuals with right precordial ST-segment-elevation Brugada syndrome
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DOI：
10.1161/01.cir.0000153267.21278.8d
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发表时间：
2005-01-25
期刊：
影响因子：
37.8
通讯作者：
Wilde, AAM
中科院分区：
文献类型：
--
作者：
Eckardt, L;Probst, V;Wilde, AAM
背景 - Brugada 综合征是一种致心律失常疾病，其特征是心电图右心前导联 ST 段抬高，并且心室颤动导致心源性猝死的风险增加。关于风险分层和治疗管理存在争议，特别是在无症状个体中。方法和结果 - 对总共 212 名具有 1 型 Brugada 心电图模式的个体（平均年龄，45 +/- 6 岁）进行了研究。其中，123 例（58%）无症状，65 例（31%）有大于或等于 1 次不明原因晕厥，24 例（11%）因心室颤动而必须进行复苏。 125 名个体 (59%) 记录了自发 1 型心电图。在剩下的实验中，使用 I 类抗心律失常药物进行药物激发后发现了 Brugada 心电图。有症状患者的平均 ST 抬高为 2.3 +/- 1.2 毫米，无症状患者的平均 ST 抬高为 1.9 +/- 1.5 毫米（P = 0.04）。在平均 40 +/- 50 个月的随访期间，24 名心源性猝死中止患者中的 4 名 (17%) 和 65 名既往晕厥患者中的 4 名 (6%) 发生过复发性心律失常事件，而 123 名无症状个体中只有 1 名 (0.8%) 发生首次心律失常事件。随访期间出现心律失常事件的 9 名患者中有 4 名在程序化电刺激过程中未诱发心律失常事件。先前的猝死或晕厥病史以及自发 1 型心电图的存在是不良结果的预测因素。 结论 - 本研究报告了具有 1 型 Brugada 心电图模式的大量个体的数据，且具有迄今为止报道的最长随访时间。在随访过程中发现，严重心律失常事件的发生率非常低，特别是在无症状个体中。在随访中很少出现心律失常事件的情况下，程序化电刺激在预测结果方面显示出非常低的准确性。
Background - Brugada syndrome is an arrhythmogenic disease characterized by an ECG pattern of ST-segment elevation in the right precordial leads and an increased risk of sudden cardiac death as a result of ventricular fibrillation. Controversy exists with regard to risk stratification and therapeutic management, particularly in asymptomatic individuals.Methods and Results - A total of 212 individuals ( mean age, 45 +/- 6 years) with a type 1 Brugada ECG pattern were studied. Of these, 123 (58%) were asymptomatic, 65 (31%) had greater than or equal to 1 syncope of unknown origin, and 24 (11%) had to be resuscitated because of ventricular fibrillation. In 125 individuals (59%), a spontaneous type 1 ECG was recorded. In the remaining, drug challenge with a class I antiarrhythmic agent unmasked a Brugada ECG. The mean ST elevation was 2.3 +/- 1.2 mm in symptomatic patients and 1.9 +/- 1.5 mm in asymptomatic individuals ( P = 0.04). During a mean follow-up of 40 +/- 50 months, 4 of the 24 patients (17%) with aborted sudden cardiac death and 4 of 65 (6%) with a prior syncope had a recurrent arrhythmic event, whereas only 1 of 123 asymptomatic individuals (0.8%) had a first arrhythmic event. Four of 9 patients with arrhythmic events during follow-up were not inducible during programmed electrical stimulation. A previous history of aborted sudden death or syncope and the presence of a spontaneous type 1 ECG were predictors of adverse outcome.Conclusions - The present study reports data on a large population of individuals with a type 1 Brugada ECG pattern with the longest follow-up reported so far. A very low incidence of severe arrhythmic events, particularly in asymptomatic individuals, was found during follow-up. In the presence of very few arrhythmic events on follow-up, programmed electrical stimulation showed very little accuracy in predicting outcome.