Prognostic significance of early repolarization in inferolateral leads in Brugada patients with documented ventricular fibrillation: A novel risk factor for Brugada syndrome with ventricular fibrillation

Hiro Kawata, Hiroshi Morita, Yuko Yamada, Takashi Noda, Kazuhiro Satomi, Takeshi Aiba, Mitsuaki Isobe, Satoshi Nagase, Kazufumi Nakamura, Kengo Fukushima Kusano, Hiroshi Itoh, Shiro Kamakura, Wataru Shimizu

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Abstract

Background Little is known about the clinical and prognostic impact of early repolarization (ER) on patients with Brugada syndrome (BrS), especially those with documented ventricular fibrillation (VF). Objective To investigate the prevalence and prognostic significance of ER in inferolateral leads in patients with BrS and documented VF. Methods We investigated 10 different 12-lead electrocardiograms (ECGs) recorded on different days to identify the presence of ER, which was defined as J-point elevation ≥0.1 mV in inferior (II, III, aVF) or lateral leads (I, aVL, V4-V6), in 49 individuals (46 men; age 46 ± 13 years) with a type 1 ECG of BrS and previous history of VF. Results ER was observed persistently (in all ECGs) in 15 patients (31%; P group), intermittently (in at least one but not in all ECGs) in 16 patients (33%; I group), and not observed in 18 patients (37%; N group), yielding an overall ER incidence of 63% (31/49). During the follow-up period (7.7 years), recurrence of VF was documented in all 15 patients (100%) in the P group, and less in 12 patients (75%) in the I group and in 8 patients (44%) in the N group. The P group showed a worse prognosis than N group (P =.0001) by Kaplan-Meier analysis. Either persistent or intermittent ER in an inferolateral lead was an independent predictor of fatal arrhythmic events (hazard ratio 4.88, 95% confidence interval 2.02-12.7, P =.0004; and hazard ratio 2.50, 95% confidence interval 1.03-6.43, P =.043, respectively). Conclusion The prevalence of ER in inferolateral leads was high and an especially persistent form of ER was associated with a worse outcome in BrS patients with documented VF.

Original languageEnglish
Pages (from-to)1161-1168
Number of pages8
JournalHeart Rhythm
Volume10
Issue number8
DOIs
Publication statusPublished - Aug 2013

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Brugada Syndrome
Ventricular Fibrillation
Electrocardiography
Confidence Intervals
Kaplan-Meier Estimate
Recurrence

Keywords

  • Brugada syndrome
  • Early repolarization
  • Idiopathic ventricular fibrillation
  • J wave
  • Sudden death

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Prognostic significance of early repolarization in inferolateral leads in Brugada patients with documented ventricular fibrillation : A novel risk factor for Brugada syndrome with ventricular fibrillation. / Kawata, Hiro; Morita, Hiroshi; Yamada, Yuko; Noda, Takashi; Satomi, Kazuhiro; Aiba, Takeshi; Isobe, Mitsuaki; Nagase, Satoshi; Nakamura, Kazufumi; Fukushima Kusano, Kengo; Itoh, Hiroshi; Kamakura, Shiro; Shimizu, Wataru.

In: Heart Rhythm, Vol. 10, No. 8, 08.2013, p. 1161-1168.

Research output: Contribution to journalArticle

Kawata, Hiro ; Morita, Hiroshi ; Yamada, Yuko ; Noda, Takashi ; Satomi, Kazuhiro ; Aiba, Takeshi ; Isobe, Mitsuaki ; Nagase, Satoshi ; Nakamura, Kazufumi ; Fukushima Kusano, Kengo ; Itoh, Hiroshi ; Kamakura, Shiro ; Shimizu, Wataru. / Prognostic significance of early repolarization in inferolateral leads in Brugada patients with documented ventricular fibrillation : A novel risk factor for Brugada syndrome with ventricular fibrillation. In: Heart Rhythm. 2013 ; Vol. 10, No. 8. pp. 1161-1168.
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abstract = "Background Little is known about the clinical and prognostic impact of early repolarization (ER) on patients with Brugada syndrome (BrS), especially those with documented ventricular fibrillation (VF). Objective To investigate the prevalence and prognostic significance of ER in inferolateral leads in patients with BrS and documented VF. Methods We investigated 10 different 12-lead electrocardiograms (ECGs) recorded on different days to identify the presence of ER, which was defined as J-point elevation ≥0.1 mV in inferior (II, III, aVF) or lateral leads (I, aVL, V4-V6), in 49 individuals (46 men; age 46 ± 13 years) with a type 1 ECG of BrS and previous history of VF. Results ER was observed persistently (in all ECGs) in 15 patients (31{\%}; P group), intermittently (in at least one but not in all ECGs) in 16 patients (33{\%}; I group), and not observed in 18 patients (37{\%}; N group), yielding an overall ER incidence of 63{\%} (31/49). During the follow-up period (7.7 years), recurrence of VF was documented in all 15 patients (100{\%}) in the P group, and less in 12 patients (75{\%}) in the I group and in 8 patients (44{\%}) in the N group. The P group showed a worse prognosis than N group (P =.0001) by Kaplan-Meier analysis. Either persistent or intermittent ER in an inferolateral lead was an independent predictor of fatal arrhythmic events (hazard ratio 4.88, 95{\%} confidence interval 2.02-12.7, P =.0004; and hazard ratio 2.50, 95{\%} confidence interval 1.03-6.43, P =.043, respectively). Conclusion The prevalence of ER in inferolateral leads was high and an especially persistent form of ER was associated with a worse outcome in BrS patients with documented VF.",
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author = "Hiro Kawata and Hiroshi Morita and Yuko Yamada and Takashi Noda and Kazuhiro Satomi and Takeshi Aiba and Mitsuaki Isobe and Satoshi Nagase and Kazufumi Nakamura and {Fukushima Kusano}, Kengo and Hiroshi Itoh and Shiro Kamakura and Wataru Shimizu",
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T1 - Prognostic significance of early repolarization in inferolateral leads in Brugada patients with documented ventricular fibrillation

T2 - A novel risk factor for Brugada syndrome with ventricular fibrillation

AU - Kawata, Hiro

AU - Morita, Hiroshi

AU - Yamada, Yuko

AU - Noda, Takashi

AU - Satomi, Kazuhiro

AU - Aiba, Takeshi

AU - Isobe, Mitsuaki

AU - Nagase, Satoshi

AU - Nakamura, Kazufumi

AU - Fukushima Kusano, Kengo

AU - Itoh, Hiroshi

AU - Kamakura, Shiro

AU - Shimizu, Wataru

PY - 2013/8

Y1 - 2013/8

N2 - Background Little is known about the clinical and prognostic impact of early repolarization (ER) on patients with Brugada syndrome (BrS), especially those with documented ventricular fibrillation (VF). Objective To investigate the prevalence and prognostic significance of ER in inferolateral leads in patients with BrS and documented VF. Methods We investigated 10 different 12-lead electrocardiograms (ECGs) recorded on different days to identify the presence of ER, which was defined as J-point elevation ≥0.1 mV in inferior (II, III, aVF) or lateral leads (I, aVL, V4-V6), in 49 individuals (46 men; age 46 ± 13 years) with a type 1 ECG of BrS and previous history of VF. Results ER was observed persistently (in all ECGs) in 15 patients (31%; P group), intermittently (in at least one but not in all ECGs) in 16 patients (33%; I group), and not observed in 18 patients (37%; N group), yielding an overall ER incidence of 63% (31/49). During the follow-up period (7.7 years), recurrence of VF was documented in all 15 patients (100%) in the P group, and less in 12 patients (75%) in the I group and in 8 patients (44%) in the N group. The P group showed a worse prognosis than N group (P =.0001) by Kaplan-Meier analysis. Either persistent or intermittent ER in an inferolateral lead was an independent predictor of fatal arrhythmic events (hazard ratio 4.88, 95% confidence interval 2.02-12.7, P =.0004; and hazard ratio 2.50, 95% confidence interval 1.03-6.43, P =.043, respectively). Conclusion The prevalence of ER in inferolateral leads was high and an especially persistent form of ER was associated with a worse outcome in BrS patients with documented VF.

AB - Background Little is known about the clinical and prognostic impact of early repolarization (ER) on patients with Brugada syndrome (BrS), especially those with documented ventricular fibrillation (VF). Objective To investigate the prevalence and prognostic significance of ER in inferolateral leads in patients with BrS and documented VF. Methods We investigated 10 different 12-lead electrocardiograms (ECGs) recorded on different days to identify the presence of ER, which was defined as J-point elevation ≥0.1 mV in inferior (II, III, aVF) or lateral leads (I, aVL, V4-V6), in 49 individuals (46 men; age 46 ± 13 years) with a type 1 ECG of BrS and previous history of VF. Results ER was observed persistently (in all ECGs) in 15 patients (31%; P group), intermittently (in at least one but not in all ECGs) in 16 patients (33%; I group), and not observed in 18 patients (37%; N group), yielding an overall ER incidence of 63% (31/49). During the follow-up period (7.7 years), recurrence of VF was documented in all 15 patients (100%) in the P group, and less in 12 patients (75%) in the I group and in 8 patients (44%) in the N group. The P group showed a worse prognosis than N group (P =.0001) by Kaplan-Meier analysis. Either persistent or intermittent ER in an inferolateral lead was an independent predictor of fatal arrhythmic events (hazard ratio 4.88, 95% confidence interval 2.02-12.7, P =.0004; and hazard ratio 2.50, 95% confidence interval 1.03-6.43, P =.043, respectively). Conclusion The prevalence of ER in inferolateral leads was high and an especially persistent form of ER was associated with a worse outcome in BrS patients with documented VF.

KW - Brugada syndrome

KW - Early repolarization

KW - Idiopathic ventricular fibrillation

KW - J wave

KW - Sudden death

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