Spontaneous electrocardiogram alterations predict ventricular fibrillation in Brugada syndrome
Spontaneous electrocardiogram alterations predict ventricular fibrillation in Brugada syndrome
复制标题
DOI：
10.1016/j.hrthm.2011.02.009
复制
发表时间：
2011-07-01
期刊：
影响因子：
5.5
通讯作者：
Zipes, Douglas P.
中科院分区：
文献类型：
--
作者：
Take, Yutaka;Morita, Hiroshi;Zipes, Douglas P.
背景Brugada综合征（BS）患者的心电图常发生自发性改变。目的探讨BS患者和BS实验模型的心电图改变与室颤（VF）发生的关系。方法在研究1中，我们观察了BS患者的心电图改变，并与正常对照组比较。结果在研究2中，BS患者的心电图改变与室颤的发生有显著性差异（P < 0.05），而在研究3中，BS患者的心电图改变与室颤的发生无显著性差异（P > 0.05）。结论BS患者的心电图改变与室颤的发生有显著性差异（P < 0.05（VF+，n = 33）和无（VF-，n = 41）自发性VF。我们将0型ECG定义为无负T波的覆盖型ST段抬高，这代表存在圆顶丢失（LOD）型动作电位（AP）。在研究2中，我们光学标测心外膜AP，并记录34只犬右心室组织的透壁ECG与药物诱导的BS模型的吡那地尔和pilsicainide.Results在研究1中，ST水平的变化>= 0.2 mV的VF+组比VF-组更频繁（P <0.01）。VF+组的自发性心电图改变和1型和0型心电图的出现比VF-组更频繁（P <0.01）。在研究2中，具有尖峰圆顶（SAD）心外膜AP的BS模型表现出1型ECG。AP的1相切迹加深诱导AP的异质转换（SAD -> LOD），并导致ECG从1型转换为0型。显著的AP异质性经常出现在AP改变期间，并启动2期折返。有室性心动过速（VT; n = 20）的组织比无室性心动过速（VT; n = 14; P <0.01）的组织AP和ECG改变更频繁。结论ECG改变，尤其是0型和1型之间的转换，与BS中可引发VF的AP异质性有关。
BACKGROUND Patients with Brugada syndrome (BS) often have spontaneous changes in their electrocardiogram (ECG).OBJECTIVE To evaluate the significance of ECG alterations, we investigated the relationships between the ECG and the occurrence of ventricular fibrillation (VF) in both patients and an experimental model of BS.METHODS In study 1, we evaluated ECG alterations in BS patients with (VF+, n = 33) and without (VF-, n = 41) spontaneous VF. We defined type 0 ECG as coved-type ST elevation without a negative T wave, which represents the existence of loss-of-dome (LOD) type action potentials (APs). In study 2, we optically mapped epicardial APs and recorded transmural ECGs in 34 canine right ventricular tissues with a drug-induced BS model by a combination of pinacidil and pilsicainide.RESULTS In study 1, changes in ST level >= 0.2 mV were more frequent in the VF+ group than in the VF- group (P < .01). Spontaneous ECG alterations and appearances of types 1 and 0 ECGs were more frequent in the VF+ group than in the VF- group (P < .01). In study 2, BS model with spike-and-dome (SAD) epicardial APs exhibited type 1 ECG. Deepening of the phase 1 notch of the APs induced heterogeneous conversion of the APs (SAD -> LOD) and resulted in ECG conversion from type 1 to type 0. Significant AP heterogeneity often appeared during AP alterations and initiated phase 2 reentry. Tissues having ventricular tachycardia (VT; n = 20) had more frequent alterations in APs and ECG than in tissues without VT (n = 14; P < .01).CONCLUSION ECG alterations, especially conversion between types 0 and 1, are associated with significant AP heterogeneity that can initiate VF in BS.