Prognostic Significance of the Sodium Channel Blocker Test in Patients With Brugada Syndrome.
Prognostic Significance of the Sodium Channel Blocker Test in Patients With Brugada Syndrome.
复制标题
Brugada综合征患者钠通道阻滞剂测试的预后意义。
DOI：
10.1161/jaha.118.008617
复制
发表时间：
2018-05-10
影响因子：
5.4
通讯作者：
Ito H
中科院分区：
文献类型：
--
作者：
Ueoka A;Morita H;Watanabe A;Morimoto Y;Kawada S;Tachibana M;Miyamoto M;Nakagawa K;Nishii N;Ito H
使用钠通道阻滞剂（SCB）的药物激发试验可以揭示Brugada综合征患者的1型ECG模式。然而，SCB激发结果的预后价值在非1型ECG患者中有限。我们研究了未来室颤风险与SCB诱导的ECG变化和室性快速性心律失常（VTA）的相关性。我们连续对245例Brugada综合征患者（181例自发1型ECG，64例非1型ECG）静脉注射吡西卡尼。评价了试验前后的ECG参数和药物诱导的VTA的发生率。在113±57个月的平均随访期内，31例患者发生了致死性VTA事件（猝死：n=3，室性心动过速/室颤：n=28）。有症状的患者和自发1型ECG与未来的致死性心血管事件相关。测试后ECG参数的单变量分析显示，长PQ和QRS间期、高ST水平和SCB诱导的VTA与随访期间的后期VTA事件相关。多变量分析显示，有症状的患者、测试后ST段抬高（V1）≥0.3 mV和SCB诱发的VTA是未来致命性心血管事件的独立预测因素（风险比：3.28、2.80和3.62，95%置信区间分别为：1.54-7.47、1.32-6.35和1.64-7.75; P<0.05）。 在Brugada综合征患者中，SCB诱导的VTA和ST段抬高与随访期间发生室性心动过速/室颤事件的风险增加相关。
A drug provocation test using a sodium channel blocker (SCB) can unmask a type 1 ECG pattern in patients with Brugada syndrome. However, the prognostic value of the results of an SCB challenge is limited in patients with non–type 1 ECG. We investigated the associations of future risk for ventricular fibrillation with SCB‐induced ECG changes and ventricular tachyarrhythmias (VTAs). We administered intravenous pilsicainide to 245 consecutive patients with Brugada syndrome (181 patients with spontaneous type 1 ECG, 64 patients with non–type 1 ECG). ECG parameters before and after the test and occurrence of drug‐induced VTAs were evaluated. During a mean follow‐up period of 113±57 months, fatal VTA events occurred in 31 patients (sudden death: n=3, ventricular tachycardia/ventricular fibrillation: n=28). Symptomatic patients and spontaneous type 1 ECG were associated with future fatal arrhythmic events. Univariable analysis of ECG parameters after the test showed that long PQ and QRS intervals, high ST level, and SCB‐induced VTAs were associated with later VTA events during follow‐up. Multivariable analysis showed that symptomatic patients, high ST level (V1) ≥0.3 mV after the test, and SCB‐induced VTAs were independent predictors for future fatal arrhythmic events (hazard ratios: 3.28, 2.80, and 3.62, 95% confidence intervals: 1.54–7.47, 1.32–6.35, and 1.64–7.75, respectively; P<0.05). SCB‐induced VTAs and ST‐segment augmentation are associated with an increased risk of the development of ventricular tachycardia/ventricular fibrillation events during follow‐up in patients with Brugada syndrome.