Significance of cardiac autonomic neuropathy in risk stratification of Brugada syndrome

Abstract

Aims Risk stratification in Brugada syndrome (BS) is controversial especially in asymptomatic individuals. The aim of this study was to evaluate the significance of cardiac autonomic neuropathy (CAN) in BS. Methods and results Patients diagnosed with Brugada ECG pattern were enrolled in the study. Four standard cardiac autonomic function tests were performed. The presence of 2 abnormal test results were considered definite evidence for the presence of CAN. Types 1, 2, and 3 Brugada ECG pattern were found in 28, 56, and 31 patients, respectively. CAN was detected in 13 (46%) patients with type 1 Brugada ECG pattern. In contrast, none of the type 2 or 3 Brugada patients had CAN. Of 13 patients with CAN, 11 had previous history of cardiac events (84%), whereas only 2 of 15 patients without CAN had history of previous cardiac events (13%; P ¼ 0.01). The most noteworthy finding was that all of the type 1 Brugada patients with CAN were male (CAN was not detected in females). Conclusions It was concluded that CAN is an important risk indicator in BS. CAN is more common in men. Male gender, per se, is not an independent risk factor for development of ventricular arrhythmia but also CAN, which is an important risk factor in BS, is more common in men; therefore men are susceptible to the development of cardiac events.

Autonomic Dysfunction in Patients with Brugada Syndrome: Further Biochemical Evidence of Altered Signaling Pathways

“…Recently, Babaee and co‐workers could show a reduction of sympathetic function assesses by the sustained hand grip test in patients with BrS 6 . This nicely fits to our previous studies, in which we noted (1) an impaired adrenergic innervation using [ 123 I] metaiodobenzylguanidine single‐photon emission computed tomography ([ 123 I]MIBG‐SPECT) 7 and (2) an increased myocardial presynaptic catecholamine recycling 8 .…”

Sleep-Disordered Breathing in Patients With the Brugada Syndrome

“…Therefore, autonomic instability during REM sleep and after arousals could play an important role in triggering arrhythmias. This may be especially true in Brugada patients, in whom an intrinsic autonomic impairment has been described 30–32 . Studies using 123 I-MIBG-SPECT have shown reduced tracer uptake in the left ventricle of patients with the Brugada syndrome, which is compatible with a dysfunction in myocardial sympathetic innervation.…”

“…Studies using 123 I-MIBG-SPECT have shown reduced tracer uptake in the left ventricle of patients with the Brugada syndrome, which is compatible with a dysfunction in myocardial sympathetic innervation. Those patients may also have cardiac autonomic neuropathy, based on abnormalities evident in tests of cardiovascular sympathetic function 30 . Accordingly, the dynamic changes in the ST segment were more frequent during REM sleep and after arousals.…”

Sudden Unexplained Nocturnal Death Syndrome in Central China (Hubei)

“… 4 Furthermore, as important risk indicator of SUNDS, cardiac autonomic neuropathy was more common in males. 25 Thus, SUNDS was more prone to be males; especially manual workers often have high levels of fatigue. In addition, some victims suffered from stresses like bad mood before death.…”