TY - JOUR
T1 - Significance of exercise-related ventricular arrhythmias in patients with brugada syndrome
AU - Morita, Hiroshi
AU - Asada, Saori T.
AU - Miyamoto, Masakazu
AU - Morimoto, Yoshimasa
AU - Kimura, Tomonari
AU - Mizuno, Tomofumi
AU - Nakagawa, Koji
AU - Watanabe, Atsuyuki
AU - Nishii, Nobuhiro
AU - Ito, Hiroshi
N1 - Funding Information:
This study was supported by Grants-in-Aid for Scientific Research of the Japan Society for the Promotion of Science (JSPS KAKENHI, 15K09082 to Morita), and Tailor-made Medical Treatment Program with the BioBank Japan Project from the Japan Agency for Medical Research and Development (18ek0109275h0002 to Dr Morita).
Publisher Copyright:
© 2020 The Authors.
PY - 2020/12/1
Y1 - 2020/12/1
N2 - BACKGROUND: Sinus tachycardia during exercise attenuates ST-segment elevation in patients with Brugada syndrome, whereas ST-segment augmentation after an exercise test is a high-risk sign. Some patients have premature ventricular contractions (PVCs) related to exercise, but the significance of exercise-related PVCs in patients with Brugada syndrome is still unknown. The objective of this study was to determine the significance of exercise-related PVCs for predicting occurrence of ventricular fibrillation (VF) in patients with Brugada syndrome. METHODS AND RESULTS: The subjects were 307 patients with Brugada syndrome who performed a treadmill exercise test. We evaluated the occurrence of PVCs at rest, during exercise and at the peak of exercise, and during recovery after exercise (0–5 minutes). We followed the patients for 92±68 months and evaluated the occurrence of VF. PVCs occurred in 82 patients (27%) at the time of treadmill exercise test: PVCs appeared at rest in 14 patients (4%), during exercise in 60 patients (20%), immediately after exercise (0–1.5 minutes) in 28 patients (9%), early after exercise (1.5–3 minutes) in 18 patients (6%), and late after exercise (3–5 minutes) in 12 patients (4%). Thirty patients experienced VF during follow-up. Multivariable analysis including symptoms, spontaneous type 1 ECG, and PVCs in the early recovery phase showed that these factors were independently associated with VF events during follow-up. CONCLUSIONS: PVCs early after an exercise test are associated with future occurrence of VF events. Rebound of vagal nerve activity at the early recovery phase would promote ST-segment augmentation and PVCs in high-risk patients with Brugada syndrome.
AB - BACKGROUND: Sinus tachycardia during exercise attenuates ST-segment elevation in patients with Brugada syndrome, whereas ST-segment augmentation after an exercise test is a high-risk sign. Some patients have premature ventricular contractions (PVCs) related to exercise, but the significance of exercise-related PVCs in patients with Brugada syndrome is still unknown. The objective of this study was to determine the significance of exercise-related PVCs for predicting occurrence of ventricular fibrillation (VF) in patients with Brugada syndrome. METHODS AND RESULTS: The subjects were 307 patients with Brugada syndrome who performed a treadmill exercise test. We evaluated the occurrence of PVCs at rest, during exercise and at the peak of exercise, and during recovery after exercise (0–5 minutes). We followed the patients for 92±68 months and evaluated the occurrence of VF. PVCs occurred in 82 patients (27%) at the time of treadmill exercise test: PVCs appeared at rest in 14 patients (4%), during exercise in 60 patients (20%), immediately after exercise (0–1.5 minutes) in 28 patients (9%), early after exercise (1.5–3 minutes) in 18 patients (6%), and late after exercise (3–5 minutes) in 12 patients (4%). Thirty patients experienced VF during follow-up. Multivariable analysis including symptoms, spontaneous type 1 ECG, and PVCs in the early recovery phase showed that these factors were independently associated with VF events during follow-up. CONCLUSIONS: PVCs early after an exercise test are associated with future occurrence of VF events. Rebound of vagal nerve activity at the early recovery phase would promote ST-segment augmentation and PVCs in high-risk patients with Brugada syndrome.
KW - Brugada syndrome
KW - Exercise test
KW - Premature ventricular contractions
KW - Sudden death
KW - Ventricular fibrillation
UR - http://www.scopus.com/inward/record.url?scp=85097004151&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85097004151&partnerID=8YFLogxK
U2 - 10.1161/JAHA.120.016907
DO - 10.1161/JAHA.120.016907
M3 - Article
C2 - 33222599
AN - SCOPUS:85097004151
VL - 9
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
SN - 2047-9980
IS - 23
M1 - e016907
ER -