Atrial Electrophysiological Abnormality in Patients With Brugada Syndrome Assessed by P-Wave Signal-Averaged ECG and Programmed Atrial Stimulation
Background There is evidence that some patients with Brugada syndrome (BS) exhibit atrial tachyarrhythmias including paroxysmal atrial fibrillation. We investigated whether BS associated not only with vulnerability to ventricular fibrillation, but also with vulnerability to atrial fibrillation. Meth...
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| Published in | Circulation Journal Vol. 70; no. 12; pp. 1574 - 1579 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Japan
The Japanese Circulation Society
2006
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1346-9843 1347-4820 |
| DOI | 10.1253/circj.70.1574 |
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| Abstract | Background There is evidence that some patients with Brugada syndrome (BS) exhibit atrial tachyarrhythmias including paroxysmal atrial fibrillation. We investigated whether BS associated not only with vulnerability to ventricular fibrillation, but also with vulnerability to atrial fibrillation. Methods and Results In 15 patients with BS and Brugada-type electrocardiogram (ECG) (14 men, 1 woman; age 52.8±12.9 years) and 15 age-matched control patients (12 men, 3 women; age 50.9±18.9 years), the P-wave signal-averaged ECG was recorded, and the filtered P-wave duration was derived from the vector magnitude obtained by X, Y, Z leads. In 11 of the 15 patients with BS and Brugada-type ECG, invasive electrophysiologic testing was conducted. Filtered P-wave duration was significantly increased in patients with BS and Brugada-type ECG in comparison with control subjects (143.2±12.9 vs 129.6±10.1 ms, p<0.001). Ventricular late potential (root mean square voltage <20 μV in the last 40 ms and <40 μV at a low amplitude signal duration >38 ms) was present in 10 of the 12 BS patients in whom a QRS wave signal-averaged electrogram was also recorded. In all 11 patients with Brugada-type ECG who underwent electrophysiologic testing, sustained atrial fibrillation (>5 min) was induced by 1 or 2 atrial extrastimuli. In 10 of these 11 patients, ventricular fibrillation was also induced by 2 or 3 right ventricular extrastimuli. Conclusions The electrical abnormality in BS is not limited to the ventricular level; similar changes occur in the atria. Such abnormal conduction properties could be a substrate for re-entrant atrial tachyarrhythmias. (Circ J 2006; 70: 1574 - 1579) |
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| AbstractList | There is evidence that some patients with Brugada syndrome (BS) exhibit atrial tachyarrhythmias including paroxysmal atrial fibrillation. We investigated whether BS associated not only with vulnerability to ventricular fibrillation, but also with vulnerability to atrial fibrillation.BACKGROUNDThere is evidence that some patients with Brugada syndrome (BS) exhibit atrial tachyarrhythmias including paroxysmal atrial fibrillation. We investigated whether BS associated not only with vulnerability to ventricular fibrillation, but also with vulnerability to atrial fibrillation.In 15 patients with BS and Brugada-type electrocardiogram (ECG) (14 men, 1 woman; age 52.8+/-12.9 years) and 15 age-matched control patients (12 men, 3 women; age 50.9+/-18.9 years), the P-wave signal-averaged ECG was recorded, and the filtered P-wave duration was derived from the vector magnitude obtained by X, Y, Z leads. In 11 of the 15 patients with BS and Brugada-type ECG, invasive electrophysiologic testing was conducted. Filtered P-wave duration was significantly increased in patients with BS and Brugada-type ECG in comparison with control subjects (143.2+/-12.9 vs 129.6+/-10.1 ms, p<0.001). Ventricular late potential (root mean square voltage <20 muV in the last 40 ms and <40 muV at a low amplitude signal duration >38 ms) was present in 10 of the 12 BS patients in whom a QRS wave signal-averaged electrogram was also recorded. In all 11 patients with Brugada-type ECG who underwent electrophysiologic testing, sustained atrial fibrillation (>5 min) was induced by 1 or 2 atrial extrastimuli. In 10 of these 11 patients, ventricular fibrillation was also induced by 2 or 3 right ventricular extrastimuli.METHODS AND RESULTSIn 15 patients with BS and Brugada-type electrocardiogram (ECG) (14 men, 1 woman; age 52.8+/-12.9 years) and 15 age-matched control patients (12 men, 3 women; age 50.9+/-18.9 years), the P-wave signal-averaged ECG was recorded, and the filtered P-wave duration was derived from the vector magnitude obtained by X, Y, Z leads. In 11 of the 15 patients with BS and Brugada-type ECG, invasive electrophysiologic testing was conducted. Filtered P-wave duration was significantly increased in patients with BS and Brugada-type ECG in comparison with control subjects (143.2+/-12.9 vs 129.6+/-10.1 ms, p<0.001). Ventricular late potential (root mean square voltage <20 muV in the last 40 ms and <40 muV at a low amplitude signal duration >38 ms) was present in 10 of the 12 BS patients in whom a QRS wave signal-averaged electrogram was also recorded. In all 11 patients with Brugada-type ECG who underwent electrophysiologic testing, sustained atrial fibrillation (>5 min) was induced by 1 or 2 atrial extrastimuli. In 10 of these 11 patients, ventricular fibrillation was also induced by 2 or 3 right ventricular extrastimuli.The electrical abnormality in BS is not limited to the ventricular level; similar changes occur in the atria. Such abnormal conduction properties could be a substrate for re-entrant atrial tachyarrhythmias.CONCLUSIONSThe electrical abnormality in BS is not limited to the ventricular level; similar changes occur in the atria. Such abnormal conduction properties could be a substrate for re-entrant atrial tachyarrhythmias. There is evidence that some patients with Brugada syndrome (BS) exhibit atrial tachyarrhythmias including paroxysmal atrial fibrillation. We investigated whether BS associated not only with vulnerability to ventricular fibrillation, but also with vulnerability to atrial fibrillation. In 15 patients with BS and Brugada-type electrocardiogram (ECG) (14 men, 1 woman; age 52.8+/-12.9 years) and 15 age-matched control patients (12 men, 3 women; age 50.9+/-18.9 years), the P-wave signal-averaged ECG was recorded, and the filtered P-wave duration was derived from the vector magnitude obtained by X, Y, Z leads. In 11 of the 15 patients with BS and Brugada-type ECG, invasive electrophysiologic testing was conducted. Filtered P-wave duration was significantly increased in patients with BS and Brugada-type ECG in comparison with control subjects (143.2+/-12.9 vs 129.6+/-10.1 ms, p<0.001). Ventricular late potential (root mean square voltage <20 muV in the last 40 ms and <40 muV at a low amplitude signal duration >38 ms) was present in 10 of the 12 BS patients in whom a QRS wave signal-averaged electrogram was also recorded. In all 11 patients with Brugada-type ECG who underwent electrophysiologic testing, sustained atrial fibrillation (>5 min) was induced by 1 or 2 atrial extrastimuli. In 10 of these 11 patients, ventricular fibrillation was also induced by 2 or 3 right ventricular extrastimuli. The electrical abnormality in BS is not limited to the ventricular level; similar changes occur in the atria. Such abnormal conduction properties could be a substrate for re-entrant atrial tachyarrhythmias. Background There is evidence that some patients with Brugada syndrome (BS) exhibit atrial tachyarrhythmias including paroxysmal atrial fibrillation. We investigated whether BS associated not only with vulnerability to ventricular fibrillation, but also with vulnerability to atrial fibrillation. Methods and Results In 15 patients with BS and Brugada-type electrocardiogram (ECG) (14 men, 1 woman; age 52.8±12.9 years) and 15 age-matched control patients (12 men, 3 women; age 50.9±18.9 years), the P-wave signal-averaged ECG was recorded, and the filtered P-wave duration was derived from the vector magnitude obtained by X, Y, Z leads. In 11 of the 15 patients with BS and Brugada-type ECG, invasive electrophysiologic testing was conducted. Filtered P-wave duration was significantly increased in patients with BS and Brugada-type ECG in comparison with control subjects (143.2±12.9 vs 129.6±10.1 ms, p<0.001). Ventricular late potential (root mean square voltage <20 μV in the last 40 ms and <40 μV at a low amplitude signal duration >38 ms) was present in 10 of the 12 BS patients in whom a QRS wave signal-averaged electrogram was also recorded. In all 11 patients with Brugada-type ECG who underwent electrophysiologic testing, sustained atrial fibrillation (>5 min) was induced by 1 or 2 atrial extrastimuli. In 10 of these 11 patients, ventricular fibrillation was also induced by 2 or 3 right ventricular extrastimuli. Conclusions The electrical abnormality in BS is not limited to the ventricular level; similar changes occur in the atria. Such abnormal conduction properties could be a substrate for re-entrant atrial tachyarrhythmias. (Circ J 2006; 70: 1574 - 1579) |
| Author | Takagi, Yasuhiro Yamada, Takeshi Okumura, Yasuo Kasamaki, Yuji Hashimoto, Kenichi Nakai, Toshiko Watanabe, Ichiro Okubo, Kimie Shindo, Atsushi Saito, Satoshi |
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| Cites_doi | 10.1253/circj.69.1064 10.1253/jcj.60.364 10.1046/j.1540-8167.2001.00268.x 10.1016/0002-9149(88)91167-8 10.1046/j.1540-8167.2001.00680.x 10.1016/S0735-1097(02)02167-8 10.1253/circj.68.473 10.1161/01.CIR.99.5.666 10.1046/j.1540-8167.2005.04313.x 10.1016/j.ehj.2004.01.004 10.1536/jhj.43.367 10.1016/j.ijcard.2003.05.049 10.1053/eupc.1999.0033 10.1046/j.1460-9592.2001.00112.x 10.1253/jcj.65.483 10.1016/S0735-1097(01)01197-4 10.1016/0735-1097(92)90253-J 10.1038/32675 |
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| References | 4. Boersma L, Jaarsma W, Jessurun ER, Van Hemel N, Wever E. Brugada syndrome: A case report of monomorphic ventricular tachycardia. Pacing Clin Electrophysiol 2001; 24: 112-115. 9. Ajiro Y, Hagiwara N, Kasanuki H. Assessment of markers for identifying patients at risk for life-threatening arrhythmic events in Brugada syndrome. J Cardiovasc Electrophysiol 2005; 16: 45-51. 14. Sumiyoshi M, Nakazato Y, Tokano T, Yasuda M, Mineda Y, Nakata Y, et al. Sinus node dysfunction concomitant with Brugada syndrome. Circ J 2005; 69: 1064-1067. 18. Osaka T, Yokoyama E, Yamazaki M, Ito A, Kodama I. Intraatrial conduction abnormalities in patients with Brugada-type ECG estimated by P wave triggered signal-averaged ECG (abstract). J Am Coll Cardiol 2002; 39(Suppl 1): 110. 13. Itoh H, Shimizu M, Ino H, Okeie K, Yamaguchi M, Fujimo N, et al. Arrhythmias in patients with Brugada-type electrocardiographic findings. Jpn Circ J 2001; 65: 483-486. 1. Brugada P, Brugada J. Right bundle block, persistent ST segment elevation and sudden death: A distinct clinical and electrocardiographic syndrome. A multicenter report. J Am Coll Cardiol 1992; 20: 1391-1396. 5. Mok NS, Ckan NY. Brugada syndrome presenting with sustained monomorphic ventricular tachycardia. Int J Cardiol 2004; 97: 307-309. 17. Morita H, Fukushima-Kusano K, Nagase S, Miyaji K, Hiramatsu S, Banba K, et al. Sinus node function in patients with Brugadaa-type ECG. Circ J 2004; 68: 473-476. 6. Antzelevitch C. The Brugada syndrome: Ionic basis and arrhythmia mechanisms. J Cardiovasc Electrophysiol 2001; 12: 268-272. 3. Shimada M, Miyazaki T, Miyoshi S, Soejima K, Hori S, Mitamura H, et al. Sustained monomorphic ventricular tachycardia in a patient with Brugada syndrome. Jpn Circ J 1996; 60: 364-370. 10. Chen Q, Kirsch GE, Zhang D, Brugada R, Brugada J, Brugada P, et al. Genetic basis and molecular mechanism for idiopathic ventricular fibrillation. Nature 1998; 392: 293-296. 2. Alings M, Wilde A. "Brugada" syndrome: Clinical data and suggested pathophysiological mechanism. Circulation 1999; 99: 666-673. 11. Brugada J, Brugada P, Brugada R. The syndrome of right bundle branch block ST segment elevation in V1 to V3 and sudden death: The Brugada syndrome. Europace 1999; 1: 156-166. 8. Masaki R, Watanabe I, Nakai T, Kondo K, Oshikawa N, Sugimura H, et al. Role of signal-averaged electrocardiograms for predicting the inducibility of ventricular fibrillation in the syndrome consisting of right bundle branch block and ST segment elevation in leads V1-V3. Jpn Heart J 2002; 43: 367-378. 7. Ikeda T, Sakurada H, Sakabe K, Sakata T, Takumi M, Tezuka N, et al. Assessment of noninvasive markers in identifying patients at risk in the Brugada syndrome: Insight into risk stratification. J Am Coll Cardiol 2001; 37: 1628-1634. 19. Okumura K, Watanabe I, Ohkubo K, Kofune M, Ashino S, Hashimoto K, et al. Prediction of efficacy of the pulmonary vein isolation for atrial fibrillation by signal-averaged P wave duration (abstract). Circulation 2005; 112(Suppl II): II-704. 12. Morita H, Kusano-Fukushima K, Nagase S, Fujimoto Y, Hisamatsu K, Fujio H, et al. Atrial fibrillation and atrial vulnerability in patients with Brugada syndrome. J Am Coll Cardiol 2002; 40: 1437-1444. 15. Eckardt L, Kirchhof P, Loh P, Schulze-Bahr E, Johna R, Wichter T, et al. Brugada syndrome and supraventricular tachyarrhythmias: A novel association? J Cardiovasc Electrophysiol 2001; 12: 680-685. 20. Buckingham TA, Thessen CC, Stevens LL, Redd RM, Kennedy HL. Effect of conduction defect on the signal-averaged electrocardiographic determination of late potentials. Am J Cardiol 1988; 61: 1265-1271. 16. Bordachar P, Reuter S, Garrigue S, Cai X, Hocini M, Jais P, et al. Incidence, clinical implications and prognosis of atrial arrhythmias in Brugada syndrome. Eur Heart J 2004; 25: 879-884. 11 Boersma L, Jaarsma W, Jessurun ER (4) 2001; 24 12 14 15 Brugada P, Brugada J (1) 1992; 20 Alings M, Wilde A (2) 1999; 99 Bordachar P, Reuter S, Garrigue S (16) 2004; 25 Osaka T, Yokoyama E, Yamazaki M, It (18) 2002; 39(Suppl 1) Mok NS, Ckan NY (5) 2004; 97 Okumura K, Watanabe I, Ohkubo K, Ko (19) 2005; 112(Suppl II) 3 6 7 8 9 Itoh H, Shimizu M, Ino H, Okeie K (13) 2001; 65 Morita H, Fukushima-Kusano K, Nagas (17) 2004; 68 20 10 |
| References_xml | – reference: 15. Eckardt L, Kirchhof P, Loh P, Schulze-Bahr E, Johna R, Wichter T, et al. Brugada syndrome and supraventricular tachyarrhythmias: A novel association? J Cardiovasc Electrophysiol 2001; 12: 680-685. – reference: 17. Morita H, Fukushima-Kusano K, Nagase S, Miyaji K, Hiramatsu S, Banba K, et al. Sinus node function in patients with Brugadaa-type ECG. Circ J 2004; 68: 473-476. – reference: 8. Masaki R, Watanabe I, Nakai T, Kondo K, Oshikawa N, Sugimura H, et al. Role of signal-averaged electrocardiograms for predicting the inducibility of ventricular fibrillation in the syndrome consisting of right bundle branch block and ST segment elevation in leads V1-V3. Jpn Heart J 2002; 43: 367-378. – reference: 11. Brugada J, Brugada P, Brugada R. The syndrome of right bundle branch block ST segment elevation in V1 to V3 and sudden death: The Brugada syndrome. Europace 1999; 1: 156-166. – reference: 18. Osaka T, Yokoyama E, Yamazaki M, Ito A, Kodama I. Intraatrial conduction abnormalities in patients with Brugada-type ECG estimated by P wave triggered signal-averaged ECG (abstract). J Am Coll Cardiol 2002; 39(Suppl 1): 110. – reference: 1. Brugada P, Brugada J. Right bundle block, persistent ST segment elevation and sudden death: A distinct clinical and electrocardiographic syndrome. A multicenter report. J Am Coll Cardiol 1992; 20: 1391-1396. – reference: 16. Bordachar P, Reuter S, Garrigue S, Cai X, Hocini M, Jais P, et al. Incidence, clinical implications and prognosis of atrial arrhythmias in Brugada syndrome. Eur Heart J 2004; 25: 879-884. – reference: 9. Ajiro Y, Hagiwara N, Kasanuki H. Assessment of markers for identifying patients at risk for life-threatening arrhythmic events in Brugada syndrome. J Cardiovasc Electrophysiol 2005; 16: 45-51. – reference: 12. Morita H, Kusano-Fukushima K, Nagase S, Fujimoto Y, Hisamatsu K, Fujio H, et al. Atrial fibrillation and atrial vulnerability in patients with Brugada syndrome. J Am Coll Cardiol 2002; 40: 1437-1444. – reference: 10. Chen Q, Kirsch GE, Zhang D, Brugada R, Brugada J, Brugada P, et al. Genetic basis and molecular mechanism for idiopathic ventricular fibrillation. Nature 1998; 392: 293-296. – reference: 14. Sumiyoshi M, Nakazato Y, Tokano T, Yasuda M, Mineda Y, Nakata Y, et al. Sinus node dysfunction concomitant with Brugada syndrome. Circ J 2005; 69: 1064-1067. – reference: 3. Shimada M, Miyazaki T, Miyoshi S, Soejima K, Hori S, Mitamura H, et al. Sustained monomorphic ventricular tachycardia in a patient with Brugada syndrome. Jpn Circ J 1996; 60: 364-370. – reference: 13. Itoh H, Shimizu M, Ino H, Okeie K, Yamaguchi M, Fujimo N, et al. Arrhythmias in patients with Brugada-type electrocardiographic findings. Jpn Circ J 2001; 65: 483-486. – reference: 7. Ikeda T, Sakurada H, Sakabe K, Sakata T, Takumi M, Tezuka N, et al. Assessment of noninvasive markers in identifying patients at risk in the Brugada syndrome: Insight into risk stratification. J Am Coll Cardiol 2001; 37: 1628-1634. – reference: 2. Alings M, Wilde A. "Brugada" syndrome: Clinical data and suggested pathophysiological mechanism. Circulation 1999; 99: 666-673. – reference: 5. Mok NS, Ckan NY. Brugada syndrome presenting with sustained monomorphic ventricular tachycardia. Int J Cardiol 2004; 97: 307-309. – reference: 4. Boersma L, Jaarsma W, Jessurun ER, Van Hemel N, Wever E. Brugada syndrome: A case report of monomorphic ventricular tachycardia. Pacing Clin Electrophysiol 2001; 24: 112-115. – reference: 6. Antzelevitch C. The Brugada syndrome: Ionic basis and arrhythmia mechanisms. J Cardiovasc Electrophysiol 2001; 12: 268-272. – reference: 19. Okumura K, Watanabe I, Ohkubo K, Kofune M, Ashino S, Hashimoto K, et al. Prediction of efficacy of the pulmonary vein isolation for atrial fibrillation by signal-averaged P wave duration (abstract). Circulation 2005; 112(Suppl II): II-704. – reference: 20. Buckingham TA, Thessen CC, Stevens LL, Redd RM, Kennedy HL. Effect of conduction defect on the signal-averaged electrocardiographic determination of late potentials. 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| Snippet | Background There is evidence that some patients with Brugada syndrome (BS) exhibit atrial tachyarrhythmias including paroxysmal atrial fibrillation. We... There is evidence that some patients with Brugada syndrome (BS) exhibit atrial tachyarrhythmias including paroxysmal atrial fibrillation. We investigated... |
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| SubjectTerms | Adult Aged Atrial fibrillation Atrial Fibrillation - etiology Atrial vulnerability Brugada syndrome Brugada Syndrome - complications Brugada Syndrome - physiopathology Case-Control Studies Electrocardiography Electrophysiologic Techniques, Cardiac Female Filtered P-wave duration Heart Atria - abnormalities Heart Atria - physiopathology Humans Male Middle Aged Signal-averaged electrocardiogram |
| Title | Atrial Electrophysiological Abnormality in Patients With Brugada Syndrome Assessed by P-Wave Signal-Averaged ECG and Programmed Atrial Stimulation |
| URI | https://www.jstage.jst.go.jp/article/circj/70/12/70_12_1574/_article/-char/en https://www.ncbi.nlm.nih.gov/pubmed/17127802 https://www.proquest.com/docview/68183573 |
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| ispartofPNX | Circulation Journal, 2006, Vol.70(12), pp.1574-1579 |
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