aVR sign as a risk factor for life-threatening arrhythmic events in patients with Brugada syndrome

Bigi, Mohamad Ali Babai; Aslani, Amir; Shahrzad, Shahab

doi:10.1016/j.hrthm.2007.04.017

Cited by 107 publications

(61 citation statements)

References 24 publications

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“…A). We evaluated specific ECG morphologies and arrhythmias and conduction disturbances associated with the Brugada syndrome: type 1 ECG at leads V1 and V2 with standard electrode positions and leads V1‐V2 positioned at the third intercostal space, fragmented QRS (fQRS), complete right bundle branch block (CRBBB), inferolateral early repolarization (ER), late R’ wave of lead aVR (aVR sign) and S wave in lead I . Spontaneous type 1 was defined as appearance of coved type ECG (J point ≥0.2 mV) without pilsicainide test (intravenous injection, 0.1 mg/kg/10 minute).…”

Section: Methodsmentioning

confidence: 99%

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Identification of electrocardiographic risk markers for the initial and recurrent episodes of ventricular fibrillation in patients with Brugada syndrome

Morita

Watanabe

Kawada

et al. 2017

Cardiovasc electrophysiol

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Introduction: New onset of ventricular fibrillation (VF) in asymptomatic patients with Brugadatype ECG is not frequent, but it cannot be negligible. Risk markers for predicting VF are usually based on results of analysis in symptomatic patients, and they have not been determined for asymptomatic patients. We analyzed ECG markers in patients with Brugada syndrome to differentiate the risk factors for VF in both symptomatic and asymptomatic patients. Methods:The subjects were 471 patients with Brugada syndrome and we divided the subjects into two groups: Asymptomatic group (n = 326) and Symptomatic group (syncope: n = 122, VF: n = 23). We analyzed the following ECG markers: RR, PQ, QRS, QT and Tpeak-Tend (Tpe) intervals, ST level, atrial fibrillation (AF), atrioventricular block, spontaneous type 1 ECG, early repolariza- tion (ER) and fragmented QRS (fQRS).Results: During follow-up (91 ± 64 months), 41 patients experienced VF (Asymptomatic: n = 10, Symptomatic: n = 31). Univariable analysis showed that spontaneous type 1 ECG, Tpe interval (≥95 milliseconds), high ST level (≥0.52 mV) and fQRS were common predictors for VF in both the Asymptomatic and Symptomatic groups. In addition to the common risk factors, wide QRS (≥107 milliseconds), long QT interval (≥420 milliseconds), ER and AF were predictors for VF in Symptomatic group. Multivariable analysis of the Symptomatic group showed fQRS, Tpe and ER were independent predictors of prognosis.Conclusions: fQRS and Tpe interval are common risk factors for VF in both asymptomatic and symptomatic patients, whereas ER is a predictor for recurrent VF.

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Section: Methodsmentioning

confidence: 99%

“…Abnormality in the electrical axis of the QRS complex including the existence of aVR sign and large S wave in lead I 11 were evaluated. The aVR sign was defined as an R wave of 0.3 mV or R/q ratio of 0.75 in lead aVR . An abnormal S wave in lead I was defined as S‐wave amplitude ≥0.1 mV and/or duration ≥40 milliseconds …”

Section: Methodsmentioning

confidence: 99%

Identification of electrocardiographic risk markers for the initial and recurrent episodes of ventricular fibrillation in patients with Brugada syndrome

Morita

Watanabe

Kawada

et al. 2017

Cardiovasc electrophysiol

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“…Moreover, markers of increased risk of ventricular arrhythmia in BS are described in other than right-ventricular leads. It has been shown that R wave amplitude in aVR lead ≥ 3 mm or the ratio of R/q ≥ 0.75 in this lead are connected with an increased risk of ventricular arrhythmia in BS [34]. …”

Section: Discussionmentioning

confidence: 99%

Usefulness of patient’s history and non-invasive electrocardiographic parameters in prediction of ajmaline test results in patients with suspected Brugada syndrome

Uziębło‐Życzkowska¹,

Gielerak²,

Michałkiewicz³

2014

aoms

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IntroductionThe aim of the work was to assess the usefulness of patient's history and non-invasive electrocardiographic parameters in the prediction of ajmaline test results in patients with suspected Brugada syndrome.Material and methodsThe study involved a group of 59 patients (37 men) at average age of 31.6 ±12.2 years with suspected concealed form of Brugada syndrome. Pharmacological provocation with intravenous ajmaline administration was performed. The patients were divided into two groups depending on ajmaline test results. Individual and total predictive value for ajmaline test was based on the analysis of medical anamnesis and non-invasive electrocardiographic examination.ResultsThe analysis carried out within the work indicated a special predictive value of 2 parameters which constituted the study inclusion criteria – family history of Brugada syndrome (28.6% vs. 3.8%; p = 0.0477) and occurrence of saddleback electrocardiographic changes in ECG curve (42.9% vs. 0.0%; p = 0.0002). Non-invasive electrocardiographic parameters which showed significant predictive value for ajmaline test were as follows: dispersion of QTc interval (prior to the provocation test 54.43 ±24.77 ms vs. 32.70 ±12.98 ms; p = 0.0005 and during daytime activity 46.81 ±27.16 ms vs. 32.07 ±13.19 ms; p = 0.0198), corrected QT intervals, Tpeak-Tend intervals in particular leads, QTpeak intervals, dispersion of Tpeak-Tend interval assessed from precordial leads (V1–V6) (42.86 ±13.80 ms vs. 26.54 ±11.70 ms; p = 0.001) and J-point elevation in V2 and V3 leads.ConclusionsBoth interview and non-invasive electrocardiographic parameters which reflect cardiomyocyte repolarization disorders are of high predictive value in anticipating ajmaline pharmacological provocation results in patients with suspected Brugada syndrome.

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“…These parameters include QRS and QT prolongation in the right precordial leads, the aVR sign, T-wave alternans, and parameters of dispersion of repolarization [45][46][47][48][49][50]. These parameters have to be evaluated in larger populations with longer follow-up with respect to the prediction of SCD.…”

Section: Electrocardiogrammentioning

confidence: 99%

Risk Stratification in Electrical Cardiomyopathies

Veltmann

Schimpf

Borggrefe

et al. 2009

Herz

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Electrical cardiomyopathies contain the long QT syndrome (LQTS), the short QT syndrome (SQTS), the Brugada syndrome, and the catecholaminergic polymorphic ventricular tachycardia (CPVT). Patients diagnosed with an electrical cardiomyopathy have an increased risk of syncope and sudden cardiac death (SCD). Usually, we are dealing with young patients or even children. The prevalence of these diseases is low. No large prospective randomized studies exist with respect to outcome based on different clinical and genetic parameters. Thus, risk stratification in these patients is based on retrospective data from single- or multicenter registries.The implantable cardioverter defibrillator is the only reliable therapy in patients with Brugada syndrome and SQTS, as no pharmacological therapy has been proven to prevent SCD. In LQTS and CPVT, the primary therapy relies on beta-blockers. In high-risk patients, the ICD is indicated.In all electrical diseases, risk stratification is based on the clinical phenotype, including the electrocardiogram, the history of unexplained or disease-related syncope, and sudden cardiac arrest. In LQTS and CPVT, demographic data like age and gender are important factors for risk stratification. The genotype contributes to risk stratification only in LQTS and CPVT.Patients with electrical cardiomyopathies have to be risk-stratified individually based on the data and the current guidelines available.

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aVR sign as a risk factor for life-threatening arrhythmic events in patients with Brugada syndrome

Cited by 107 publications

References 24 publications

Identification of electrocardiographic risk markers for the initial and recurrent episodes of ventricular fibrillation in patients with Brugada syndrome

Identification of electrocardiographic risk markers for the initial and recurrent episodes of ventricular fibrillation in patients with Brugada syndrome

Usefulness of patient’s history and non-invasive electrocardiographic parameters in prediction of ajmaline test results in patients with suspected Brugada syndrome

Risk Stratification in Electrical Cardiomyopathies

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