Inferior and Lateral Electrocardiographic Repolarization Abnormalities in Brugada Syndrome

Sarkozy, Andrea; Chierchia, Gian Battista; Paparella, Gaetano; Boussy, Tim; Asmundis, Carlo de; Roos, Marcus; Henkens, Stefan; Kaufman, Leonard; Buyl, Ronald; Brugada, Ramón; Brugada, Josép; Brugada, Pedro

doi:10.1161/circep.108.795153

Cited by 157 publications

(89 citation statements)

References 26 publications

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“…Our study expands previous knowledge on the frequency of ajmaline-induced coved-type ECG in the inferolateral leads, which was previously reported by our group in up to 4.6% of patients with BrS. 7 Conversely, presence of spontaneous type 1 ECG in the inferolateral leads has been considered an exceptional finding in BrS. In this study, we report for the first time the occurrence of spontaneous type 1 ECG in the lateral leads in 4.2% of BrS high-risk patients presenting with repolarization and depolarization abnormalities.…”

Section: Discussionsupporting

confidence: 90%

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Prevalence and Clinical Impact of Early Repolarization Pattern and QRS-Fragmentation in High-Risk Patients With Brugada Syndrome

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Asmundis

Sieira

et al. 2016

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp leads has been identified as an arrhythmic marker and might indicate regional conduction disturbance in the right ventricular outflow tract (RVOT) of patients with BrS. 12 Although the presence of repolarization and depolarization abnormalities in patients with BrS has been previously assessed, in those studies only a small portion of patients were implanted with an ICD. 7,13 Conversely, f-QRS and ERP have not been systematically investigated in high-risk patients. Moreover, a previous study on BrS patients undergoing ICD therapy showed that spontaneous type 1 ECG was not an independent predictor for further arrhythmic events. 5 In addition, nearly 13% of asymptomatic patients with an ICD presented an appropriate shock during follow-up. 5 Whether the preliminary results coming from previous studies suggest that these abnormalities could have a prognostic role in BrS, no data are available on the contributing role of ERP, f-QRS or combined ERP/f-QRS rugada syndrome (BrS) is an inheritable syndrome characterized by an increased risk of sudden death (SD) in the absence of structural heart disease. 1,2 The placement of an implantable cardioverter-defibrillator (ICD) remains the only therapy with proven efficacy to prevent SD in patients with BrS at high risk for further arrhythmic events. 3-5 Although the presence of spontaneous or drug-induced coved-type STsegment elevation in the right precordial leads (V1-3) is the ECG hallmark of the syndrome, some patients show additional early repolarization signs in the inferolateral leads, or present with depolarization abnormalities. 3,6-9 Early repolarization pattern (ERP) is a recognized risk factor for ventricular arrhythmias (VAs) in patients with BrS and may appear, on 12-lead ECG, as notching of the terminal portion of the QRS complex in the inferior and/or lateral leads. 10,11 Similarly, abnormal fragmentation of the QRS complex (f-QRS) in the right precordial Background: The phenotypic heterogeneity of Brugada syndrome (BrS) can lead some patients to show an additional inferolateral early repolarization pattern (ERP), or fragmented QRS (f-QRS). The aim of the study was to investigate the prevalence and clinical impact of f-QRS, ERP or combined f-QRS/ERP in high-risk patients with BrS.

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Section: Discussionsupporting

confidence: 90%

“…Our group previously reported the presence of inferolateral ERP in 11% of patients with BrS and an association with a more severe phenotype. 7 This subgroup was more likely symptomatic (59% of patients) and presented more frequently with spontaneous type 1 ECG (38% of patients). 4 However, no follow-up data were provided.…”

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confidence: 90%

Prevalence and Clinical Impact of Early Repolarization Pattern and QRS-Fragmentation in High-Risk Patients With Brugada Syndrome

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Asmundis

Sieira

et al. 2016

Circ J

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“…21,22 Up to 12 % of patients with BrS have the infero-lateral ER pattern. It is more frequently associated with type 1 ECG and previous symptoms, although no significant association with a worse outcome was reported, as shown by a multicentre study.…”

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confidence: 99%

“…It is more frequently associated with type 1 ECG and previous symptoms, although no significant association with a worse outcome was reported, as shown by a multicentre study. 21,22 Patients with BrS experiencing electrical storms have a higher prevalence of ER pattern. 23 Moreover, Kawata et al reported ER pattern in up to 63 % of patients with BrS and documented VF and a worse outcome when ER pattern was persistent.…”

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confidence: 99%

Brugada Syndrome and Early Repolarisation: Distinct Clinical Entities or Different Phenotypes of the Same Genetic Disease?

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Caputo

Regoli

et al. 2016

Arrhythmia &Amp; Electrophysiology Review

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General understanding of early repolarisation (ER) has dramatically changed in the last decade. For several years, ER has been considered a benign electrocardiographic (ECG) finding with high prevalence in the general population. Recently different studies have challenged this view and showed a significant association with life-threatening arrhythmias. [1][2][3][4][5] In 2008 Haïssaguerre et al. first reported an increased prevalence of a particular pattern of ER on the resting 12-lead ECG of patients with history of idiopathic ventricular fibrillation (VF) (see Figure 1). 2 In these patients, ER was characterised by elevation of the QRS-ST segment junction of at least 0.1 mV above the baseline level, manifesting as QRS slurring (a smooth transition from the QRS complex to the ST segment) or notching (a positive J deflection of at least 1 mm inscribed on the S wave) in two adjacent inferior (II, III and aVF), lateral (I, aVL, and V4-V6), or infero-lateral leads. The ER pattern was observed in 31 % of patients with idiopathic VF and in 5 % of healthy control subjects.Moreover, patients with idiopathic VF and ER pattern presented a higher risk of experiencing an arrhythmic recurrence during a 5-year follow-up.2 This observation was confirmed by a case-control study showing that J-point elevation in the inferior and lateral leads is more frequent in patients with idiopathic VF than in matched control subjects (27 % versus 8 % in inferior leads; 13 % versus 1 % in lateral leads).3 Conversely, ER localised exclusively in V4 to V6 occurs with similar frequency among patients and healthy subjects.

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“…It is seen more in male and second decade. The prevalence goes lower after second decade and the reason might be the hormones which change by aging process (14)(15)(16).…”

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Prevalance of early repolarization pattern in young healthy men

Yıldırım¹,

Avcı²,

Yıldırım³

et al. 2016

Med Sci and Discov

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Inferior and Lateral Electrocardiographic Repolarization Abnormalities in Brugada Syndrome

Cited by 157 publications

References 26 publications

Prevalence and Clinical Impact of Early Repolarization Pattern and QRS-Fragmentation in High-Risk Patients With Brugada Syndrome

Prevalence and Clinical Impact of Early Repolarization Pattern and QRS-Fragmentation in High-Risk Patients With Brugada Syndrome

Brugada Syndrome and Early Repolarisation: Distinct Clinical Entities or Different Phenotypes of the Same Genetic Disease?

Prevalance of early repolarization pattern in young healthy men

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