Autonomic Imbalance as a Property of Symptomatic Brugada Syndrome

Nakazawa, Kiyoshi; Sakurai, Tsuneharu; Takagi, Akihiko; Kishi, Ryoji; Osada, Keizo; Nanke, Toshihiko; Miyake, Fumihiko; Matsumoto, Naoki; Kobayashi, Shinichi

doi:10.1253/circj.67.511

Cited by 53 publications

(63 citation statements)

References 12 publications

(6 reference statements)

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“…Hence, it is unclear whether sodium channel dysfunction resulted in the sinus node impairment in the Brugada patients with VF induced by PES. Although the disease activity of BS is influenced by vagal nerve activity, 22,33 we did not evaluate the influence of the autonomic nervous system and the results of this study may have been influenced by autonomic nerve activity.…”

Section: Study Limitationmentioning

confidence: 90%

Sinus Node Function in Patients With Brugada-Type ECG

Morita

Fukushima‐Kusano

Nagase

et al. 2004

Circ J

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n 1992 Brugada et al reported 8 patients with right bundle branch block and persistent ST segment elevation in the right precordial leads. 1 These patients experienced episodes of syncope, and polymorphic ventricular tachycardia or VF was induced by programmed electrical stimulation (PES). It has been reported that 10-20% of cases of Brugada syndrome are caused by cardiac sodium channel mutation, 2-4 and impaired sodium channel function can explain the characteristic ST segment morphology and the occurrence of ventricular arrhythmia. [5][6][7] If mutation of the cardiac ion channel causes BS, there might be abnormal supraventricular electrophysiology. In fact, we found that patients with BS have abnormal atrial vulnerability, 8 and moreover, recent studies have shown that some cases of BS are associated with supraventricular tachyarrhythmia and sinus node dysfunction. 9-13 The present study was therefore designed to determine the characteristics of the conduction function of the sinus node and atrioventricular (AV) node in patients with a Brugada-type ECG. Methods PatientsThe subjects of this study were 59 male patients and 1 female patient with a Brugada-type ECG (13 symptomatic and 47 asymptomatic patients). The mean age of the patients was 47±10 years. Brugada-type ECG was defined as J wave (higher than 0.2 mV) and a coved-type or saddle

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Section: Study Limitationmentioning

confidence: 90%

Sinus Node Function in Patients With Brugada-Type ECG

Morita

Fukushima‐Kusano

Nagase

et al. 2004

Circ J

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“…For example, increased parasympathetic activity is suggested by a 24-hour Holter monitoring study, which showed that symptomatic BrS patients have lower mean heart rate than asymptomatic patients. 17 Moreover, right precordial STsegment elevation in BrS patients increases after intracoronary injection of the parasympathetic neurotransmitter acetylcholine. 18 Decreased sympathetic activity is suggested by clinical studies, which investigated the myocardial presynaptic and postsynaptic sympathetic function in BrS patients.…”

Section: Heart Ratementioning

confidence: 99%

Exercise-Induced ECG Changes in Brugada Syndrome

Amin

Groot

Ruijter

et al. 2009

Circ: Arrhythmia and Electrophysiology

108

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Background-Ventricular arrhythmia occurrence during exercise is reported in Brugada syndrome (BrS). Accordingly, experimental studies suggest that BrS-linked SCN5A mutations reduce sodium current more at fast heart rates. Yet, the effects of exercise on the BrS ECG phenotype have not been studied. We aimed to assess ECG responses to exercise in BrS and determine whether these responses are affected by the presence of an SCN5A mutation. Methods and Results-ECGs at baseline, at peak exercise, and during recovery were analyzed from 35 male control subjects, 25 BrS men without SCN5A mutation (BrS SCN5AϪ ), and 25 BrS men with SCN5A mutation (BrS SCN5Aϩ ; 15 with missense mutation and 10 with mutation leading to premature truncation of the protein). No differences existed in clinical phenotype between BrS groups. At baseline, BrS SCN5AϪ and BrS SCN5Aϩ patients had lower heart rates, wider QRS, shorter QT c , and higher peak J-point amplitudes than control subjects; BrS SCN5Aϩ patients also had longer PR than BrS SCN5AϪ and control subjects. Exercise resulted in PR shortening in all groups, more QRS widening in BrS SCN5Aϩ than in BrS SCN5AϪ and control subjects , and less QT shortening in BrS SCN5AϪ and BrS SCN5Aϩ than in control subjects. The latter resulted in QT c shortening in control subjects but QT c prolongation in BrS SCN5AϪ and BrS SCN5Aϩ . Finally, the increase in peak J-point amplitude during exercise was similar in all 3 groups but resulted in a coved-type pattern only in BrS SCN5AϪ and BrS SCN5Aϩ . Conclusions-Exercise aggravated the ECG phenotype in BrS. The presence of an SCN5A mutation was associated with further conduction slowing at fast heart rates. Possible mechanisms that may explain the observed ECG changes are discussed. (Circ Arrhythmia Electrophysiol. 2009;2:531-539.)

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“…20 Modulation abnormalities of the autonomic system may directly affect the ECG properties and increase vulnerability to fatal arrhythmias. 21,22 Several reports [23][24][25][26] showed, for BS patients, that ST-segment elevations on 12-lead ECGs have diurnal and daily variations; therefore, it is considered that the occurrence of events may also have circadian and daily variations. Matsuo et al 26 analyzed the circadian pattern of 30 ventricular fibrillation episodes in 12 BS patients who underwent an implantable cardioverter-defibrillator treatment and reported that ventricular fibrillation occurred more frequently at night (93%) than during the day (7%).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Late Potentials for 24 Hours Between Brugada Syndrome and Arrhythmogenic Right Ventricular Cardiomyopathy Using a Novel Signal-Averaging System Based on Holter ECG

Abe

Kobayashi

Yuzawa

et al. 2012

Circ: Arrhythmia and Electrophysiology

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Background— Late potentials (LP) detected with signal-averaged ECGs are known to be useful in identifying patients at risk of Brugada syndrome (BS) and arrhythmogenic right ventricular cardiomyopathy (ARVC). Because the pathophysiology is clearly different between these disorders, we clarified the LP characteristics of these disorders. Methods and Results— This study included 15 BS and 12 ARVC patients and 20 healthy controls. All BS patients had characteristic ECG changes and symptomatic episodes. All ARVC patients had findings that were consistent with recent criteria. Three LP parameters (filtered QRS duration, root mean square voltage of the terminal 40 ms of the filtered QRS complex, and duration of low-amplitude signals [<40 µV] in the terminal, filtered QRS complex) were continuously measured for 24 hours using a novel Holter-based signal-averaged ECG system. The incidences of LP determination in BS (80%) and ARVC (91%) patients were higher than in healthy controls (5%; P <0.0001 in both) but did not differ between BS and ARVC patients. In BS patients, the dynamic changes of all LP parameters were observed, and they were pronounced at nighttime. On the contrary, these findings were not observed in ARVC patients. When the SD values of the 3 LP parameters (filtered QRS duration, root mean square voltage of the terminal 40 ms of the filtered QRS complex, and duration of low-amplitude signals [<40 µV] in the terminal, filtered QRS complex) over 24 hours were compared for the 2 patient groups, those values in BS patients were significantly greater than those in ARVC patients ( P <0.0001 in all). Conclusions— LP characteristics detected by the Holter-based signal-averaged ECG system over 24 hours differ between BS and ARVC patients. Dynamic daily variations of LPs were seen only in BS patients. This may imply that mechanisms of lethal ventricular arrhythmia in BS may be more correlated with autonomic abnormality than that of ARVC.

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Autonomic Imbalance as a Property of Symptomatic Brugada Syndrome

Cited by 53 publications

References 12 publications

Sinus Node Function in Patients With Brugada-Type ECG

Sinus Node Function in Patients With Brugada-Type ECG

Exercise-Induced ECG Changes in Brugada Syndrome

Comparison of Late Potentials for 24 Hours Between Brugada Syndrome and Arrhythmogenic Right Ventricular Cardiomyopathy Using a Novel Signal-Averaging System Based on Holter ECG

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