High-degree right bundle branch block obscuring the diagnosis of Brugada electrocardiographic pattern

Chiale, Pablo A.; Garro, Hugo A.; Fernández, Pablo; Elizari, Marcelo V.

doi:10.1016/j.hrthm.2012.01.028

Cited by 41 publications

(40 citation statements)

References 6 publications

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“…The Brugada Consensus Report proposed that a sodium channel blockade is required to diagnose BrS in the absence of a coved‐type ST‐segment elevation 2. Moreover, some reports have demonstrated that the J waves in BrS are concealed by CRBBB 8, 9. In this case, the 12‐lead ECG also exhibited CRBBB, which masked the typical coved‐type ST‐segment elevation.…”

Section: Discussionmentioning

confidence: 78%

Sodium channel blockade unmasked Brugada electrocardiographic pattern in a patient with complete right bundle branch block and early repolarization in the lateral leads

Konishi

Minamiguchi

Okuyama

et al. 2016

Clinical Case Reports

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Section: Discussionmentioning

confidence: 78%

Sodium channel blockade unmasked Brugada electrocardiographic pattern in a patient with complete right bundle branch block and early repolarization in the lateral leads

Konishi

Minamiguchi

Okuyama

et al. 2016

Clinical Case Reports

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“…The resolution of CRBBB occurred spontaneously (n=1), 7 or it might be induced by the pacing technique (n=3), that is, the Chiale intervention. 13 Second, new J/ST changes appeared that could not be explained by CRBBB but could have been attributable to coved type ST-segment elevation. The new ECG changes appeared spontaneously on repeated ECG recordings (n=3) or were induced during the administration of class I C drugs (n=2).…”

Section: Definitions Of Crbbb and Bsmentioning

confidence: 99%

“…As performed by Chiale et al, 13 pacing was attempted at the right ventricular apex to normalize the QRS complexes, and the ECG was analyzed for the characteristic pattern of BS in V 1 , V 2 , and V 3 in 2 patients during the electrophysiological study.…”

Section: Provocation Testsmentioning

confidence: 99%

Brugada Syndrome Behind Complete Right Bundle-Branch Block

et al. 2013

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V entricular fibrillation (VF) can occur in patients without structural heart diseases; when it does, it is called idiopathic VF.1,2 Among primary electric diseases, Brugada syndrome (BS) is characterized by unique ECG patterns of J/ ST/T waves.3 This ECG pattern has been shown to be associated with an increased risk of sudden cardiac death compared with control subjects, 4 and an ECG diagnosis of BS is very important for risk stratification. 5,6 Clinical Perspective on p 1054Recently, we observed a case in which the characteristic ECG phenotype of BS was unmasked by relief of complete right bundlebranch block (CRBBB); when CRBBB resolved spontaneously, the characteristic ECG pattern of BS was found to be underlying. 7A similar case was reported by others. [8][9][10] The goal of this study is to discuss patients with BS that were complicated by CRBBB and to present evidence for the presence of BS in CRBBB patients. Methods PatientsThe study consisted of 11 patients who had CRBBB with the diagnosis of BS.5 Structural heart diseases were excluded by ECG, transthoracic echocardiography, and cardiac catheterization. Coronary spasm was excluded as the cause of VF by provocation tests using acetylcholine or ergonovine maleate at catheterization. Definitions of CRBBB and BSCRBBB was defined as a late R (R′) wave presenting in V 1 or V 2 , with a slurred, wide S in leads I and V 5 /V 6 and with prolonged duration of QRS ≥120 milliseconds. 11,12 If CRBBB was seen on the baseline ECG, we divided the patients into 2 groups. One group consisted of the patients in whom ECG revealed BS and CRBBB occurred subsequently during the follow-up (n=7). The other group consisted of the patients who had CRBBB on the baseline ECG but in whom BS was diagnosed in the following situations (n=4). First, resolution of CRBBB resulted in normal ventricular conduction, in which the characteristic ECG pattern for BS could be seen. The resolution of Background-The characteristic ECG of Brugada syndrome (BS) can be masked by complete right bundle-branch block (CRBBB) and exposed by resolution of the block or pharmacological or pacing maneuvers. Methods and Results-The study consisted of 11 patients who had BS and CRBBB. BS was diagnosed before the development of CRBBB, on the resolution of CRBBB, or from new characteristic ST-segment changes that could be attributable to BS. Structural heart diseases were excluded, and coronary spasm was excluded on the basis of a provocation test at catheterization. In 7 patients, BS was diagnosed before the development of CRBBB. BS was diagnosed when CRBBB resolved spontaneously (n=1) or by right ventricular pacing (n=3). The precipitating cause for the spontaneous resolution of CRBBB, however, was not apparent. On repeated ECGs, new additional upward-convex ST-segment elevation was found in V 2 or V 3 in 3 patients. In 2 patients, new ST-segment elevation was induced by class I C drugs. The QRS duration was more prolonged in patients with BS and CRBBB compared with age-and sex-matched controls: 170±13 versus 14...

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“…[6][7][8] In the present study, a similar procedure was attempted in patients with permanent CRBBB. In an electrophysiology study, 2 catheters were positioned at high right atrium (HRA) and right ventricular apex (RVA).…”

Section: Pacing From the Right Ventricle To Resolve Crbbbmentioning

confidence: 99%

Incidence and Clinical Significance of Brugada Syndrome Masked by Complete Right Bundle-Branch Block

Nagase

Morita

Nakagawa

et al. 2015

Circ J

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2568WADA T et al. Circulation JournalOfficial Journal of the Japanese Circulation Society http://www. j-circ.or.jp occasionally induces fatal ventricular tachyarrhythmia, SCB test should be avoided in patients with type 1 ECG under baseline conditions, but it is difficult to identify type 1 in BrS patients with CRBBB. The prevalence and clinical significance of the combination of CRBBB and BrS has not been well investigated. Therefore, the present study evaluated the incidence and clinical significance of BrS with CRBBB, especially BrS masked by CRBBB. Methods SubjectsA total of 326 consecutive BrS patients (mean age, 47.4±13.6 years; male, 95.4%) and 20 control subjects were enrolled in this study. All BrS patients were diagnosed as having BrS based on HRS/EHRA/APHRS expert consensus statement. 1 Type 1 ECG was documented spontaneously or was provoked by SCB test (pilsicainide, at a dose of 1 mg/kg for 5-10 min) in all BrS patients. Echocardiography was performed to exclude rugada syndrome (BrS) is characterized by ST-segment elevation at the J point in the right precordial electrocardiographic (ECG) leads and sudden cardiac death caused by polymorphic ventricular tachycardia/ventricular fibrillation (PVT/VF). This ST-segment elevation is the most important characteristic for diagnosis of BrS, 1,2 and spontaneous ST-segment elevation is reported to be a high risk for PVT/VF.

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High-degree right bundle branch block obscuring the diagnosis of Brugada electrocardiographic pattern

Cited by 41 publications

References 6 publications

Sodium channel blockade unmasked Brugada electrocardiographic pattern in a patient with complete right bundle branch block and early repolarization in the lateral leads

Sodium channel blockade unmasked Brugada electrocardiographic pattern in a patient with complete right bundle branch block and early repolarization in the lateral leads

Brugada Syndrome Behind Complete Right Bundle-Branch Block

Incidence and Clinical Significance of Brugada Syndrome Masked by Complete Right Bundle-Branch Block

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