Álvarez-Gómez JA, Dorantes SM, Stanley J, Stusser BR, Castro HJ, Barrera SD, Rivas EE, Dorticós BF

Language: Spanish
References: 25
Page: 52-58
PDF size: 85.91 Kb.

ABSTRACT

Throughout the 13 years of recognizing the Brugada syndrome as a separate entity, there has been a search for invasive and non-invasive markers for detecting risk of life-threatening arrhythmic events, particularly for asymptomatic individuals in whom the first manifestation may be sudden cardiac death. Hence, the preclinical diagnosis is pivotal for adequate and timely preventive measures. The objective of this study was to compare various non-invasive markers to characterize and stratify patients at risk. Late potentials, QT interval, QT dispersion, and heart variability were analyzed over a two-year period, in 20 patients (17 men and 3 women) with the Brugada syndrome (symptomatic and asymptomatic) and compared with 20 normal individuals similar in age and gender (control group). Late potentials were present in 80% of patients versus 5% in the control group (p ‹ 0.0001); all of these with recurrent episodes had late potentials. In conclusion, this is the most important non-invasive marker for risk stratification, recurrences and inducibility of malignant arrhythmias during electrophysiological testing. Markers, invasive and non-invasive, should be considered integrally, for a better diagnostic and prognostic approach to reality.

REFERENCES

1. BRUGADA P, BRUGADA J: Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome. JACC 1992; 20: 1391-6.

2. WILDE AAM, ANTZELEVITCH C, BORGGREFE M, BRUGADA J, BRUGADA R, BRUGADA P, ET AL: Proposed diagnostic criteria for the Brugada syndrome. Consensus report. Circulation 2002; 106: 2514-24.

3. DORANTES SM, CASTRO HJ, TORNÉS BF, QUIÑONES PMA, ZAYAS MR, DORTICÓS BF: Muerte súbita por causa eléctrica en sujetos sin enfermedad cardíaca estructural demostrable. Experiencia cubana. Arch Cardiol Méx 2004; 74: 283-9.

4. DORTICÓS BF, DORANTES SM, ARBAIZA SJL, CASTRO HJ, ZAYAS MR, QUIÑONES PMA, ET AL: Síndrome de Brugada: experiencia cubana 2001. Arch Cardiol Méx 2002; 72: 203-8.

5. GUSSAK I, HAMMILL SC: Clinical diagnosis and risk stratification in patients with Brugada syndrome. JACC 2001; 37: 635-8.

6. SURAWICZ B: Síndrome de Brugada: manifiesto, oculto, asintomático, sospechado y simulado. JACC 2002 (ed. española); 11: 106-9.

7. ANTZELEVITCH C, BRUGADA P, BORGGREFE M, BRUGADA J, BRUGADA R, CORRADO D, ET AL: Brugada syndrome: report of the Second Consensus Conference: endorsed by the Heart Rhythm Society and the European Heart Rhythm Association. Circulation 2005; 111: 659-70.

8. ANTZELEVITCH C, BRUGADA P, BRUGADA J, BRUGADA R, TOWBIN JA, NADEMANEE K: Brugada syndrome: 1992-2002: a historical perspective. JACC 2003; 41: 1665-71.

9. ANTZELEVITCH C: Late potentials and the Brugada syndrome. JACC 2002; 39: 1996-9.

10. ECKARDT L, BRUNS HJ, PAUL M, KIRCHHOF P, SCHULZE-BAHR E, WHICHTER T, ET AL: Body surface area of ST elevation and the presence of late potentials correlate to the inducibility of ventricular tachyarrhythmias in Brugada syndrome. J Cardiovasc Electrophysiol 2002; 13: 742-9.

11. 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: 367-78.

12. ROSENBAUM DS, ALBRECHT P, COHEN RJ: Predicting sudden cardiac death from T-wave alternans of the surface electrocardiogram: promise and pitfalls. J Cardiovasc Electrophysiol 1996; 7: 1095-111.

13. Task Force of the European Society and the North American Society of Pacing and Electrophysiology. Heart rate variability, standards of measurements, physiological interpretation and clinical use. Circulation 1996; 93: 1043-64.

14. BREITHARDT G, CAIN ME, EL SHERIF N, FLOWERS NC, HOMBACH V, JANSE M, ET AL: Standards for analysis of ventricular late potentials using high resolution or signal-averaged electrocardiography: A statement by the Task Force Committee of the European Society of Cardiology, the American College of Cardiology and the American Heart Association. JACC 1991; 17: 999-1006.

15. IKEDA T: Brugada syndrome: current clinical aspects and risk stratification. ANE 2002; 7: 251-62.

16. IKEDA T: Non-invasive markers to identify patients at risk in the Brugada syndrome: insight into risk stratification. First Virtual Symposium about the Brugada syndrome 2002.

17. IKEDA T, SAKURADA H, SAKABE K, SAKATA T, TAKAMI M, TEZUKA N, ET AL: Assessment of non-invasive markers in identifying patients at risk in the Brugada syndrome: inside into risk stratification. JACC 2001; 37: 1628-34.

18. HUIKURI HV: Heart rate dynamics and vulnerability to ventricular tachyarrhythmias. Ann Med 1997; 28: 321-5.

19. KAUTZNER J, YI G, CAMM AJ, MALIK M: Short and long-term reproducibility of QT, QTc and QT dispersion in healthy subjects. PACE 1994; 17: 928-37.

20. BRUGADA J, BRUGADA R, BRUGADA P: Natural history in patients with the Brugada syndrome. First Virtual Symposium about the Brugada syndrome 2002.

21. BRUGADA J, BRUGADA R, ANTZELEVITCH C, TOWBIN J, NADEMANEE K, BRUGADA P: Long-term followup of individuals with the electrocardiographic pattern of right bundle-branch block and ST-segment elevation in precordial leads V1 to V3. Circulation 2002; 105: 73-81.

22. BELHASSEN B, VISKIN S, ANTZELEVITCH C: The Brugada syndrome: is an implantable cardioverter defibrillator the only therapeutic option? PACE 2002; 25: 1634-40.

23. ECKARDT L, PROBST V, SMITS JP, BAHR ES, WOLPERT C, SCHIMPF R, ET AL: Long-term prognosis of individuals with right precordial ST-segment-elevation Brugada syndrome. Circulation 2005; 111: 257-63.

24. BRUGADA P, BRUGADA R, MONT L, RIVERO M, GEELEN P, BRUGADA J: Natural history of Brugada syndrome: the prognostic value of programmed electrical stimulation of the heart. J Cardiovasc Electrophysiol 2003; 14: 455-7.

25. PACHÓN MJC, PACHÓN MEI, PACHÓN MJC, ALBORNOZ RN, LOBO TJ: Defibrillator in the Brugada syndrome. First Virtual Symposium about the Brugada syndrome 2002.