Abstract 12239: Patients With Non-type 1 Brugada-pattern ECGs Show Clinical Profiles Similar to Brugada Syndrome in the Inferolateral Early Repolarization Syndrome
Introduction: About 30% of patients with inferolateral early repolarization syndrome (ERS) are reported to show clinical characteristics similar to Brugada syndrome (BS). Although type-1 Brugada ECGs in leads V1-V3 are excluded from ERS in the definition by Haïssaguerre et al, patients with non-type 1 Brugada-pattern ECGs (NB) can be included in ERS. We hypothesized that patients with NB and ERS account for a group showing clinical profiles similar to BS.
Methods: Drug provocation tests with a sodium channel blocker were conducted during standard and high costal (2nd and 3rd) ECG recording in 23 patients (21 men and 2 women, age 40.7±14.4 years) with a prior episode of ventricular fibrillation (VF) and inferolateral ER with a J wave ≥ 1mm in at least 2 leads. NB was defined as an ECG pattern showing type 2, type 3, or coved ST elevation with J wave amplitude of 1mm∼2mm in the upper chest leads even after drug test, never changing to type 1. Clinical data including patient's activity at VF, the location of the ER, J wave elevation after drug provocation test, VF inducibility by programmed electrical stimulation (PES), and prognosis during 55±36 months of followup were compared between patients with NB (NB group) and those without (pERS group).
Results: Eight (35%) of 23 patients had NB. VF had developed during sleep or near sleep in 7 of 8 patients in the NB group, in contrast to 1 of 15 patients in the pERS group (p<0.001). ER was noted in the lateral leads in 6 of 8 patients in the NB group, but in the inferior leads in 12 of 15 patients in the pERS group. J waves were augmented by sodium channel blocker in 2 patients in the NB group, while it was decreased in size or unchanged in all patients in the pERS group. Two patients in the NB group developed electrical storm by VF, but no patients in the pERS group had fatal arrhythmic events during followup. VF inducibility by PES was not different between the 2 groups.
Conclusions: Patients with non-type 1 Brugada-pattern ECGs, who represented 35% of ERS patients, had clinical findings consistent with BS. Pure ERS without NB showed much better prognosis and distinct profiles as idiopathic VF.
- © 2010 by American Heart Association, Inc.