Utility of T-wave alternans during night time as a predictor for ventricular fibrillation in patients with Brugada syndrome

Sakamoto, Shogo; Takagi, Masahiko; Tatsumi, Hiroaki; Doi, Atsushi; Sugioka, Kenichi; Hanatani, Akihisa; Yoshiyama, Minoru

doi:10.1007/s00380-015-0692-y

Cited by 22 publications

(6 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…T-wave alternans, or QRS complex amplitude, which is the axis between heart beats or the wandering baseline, also supports the hypothesis (Nishizaki et al, 2005;Uchimura-Makita et al, 2014;Sakamoto et al, 2015). The T-wave is negative in Figure 4F and during the hatched phase, the membrane potential gradients of the RV and RVOT are reversed (Wilde et al, 2010;Meregalli et al, 2005).…”

Section: Repolarization Hypothesissupporting

confidence: 65%

Two hypotheses of Brugada Syndrome – Repolarization and Depolarization: Literature Review

Koo¹,

Hutt²

2021

J Stud Res

View full text Add to dashboard Cite

Brugada syndrome is a recently discovered cardiac disease. The mechanisms behind this syndrome are unknown, but scientists are able to hypothesize possible mechanisms through various studies of electrocardiograms, canine wedge preparations, and genetic mutations. This review goes over two of the most potential hypotheses that explain the causes of the Brugada syndrome: the repolarization and depolarization hypotheses. Studies by Zhang et al., Wilde et al., Postema et al., Meregalli et al., Tse et al., and other scientists are reviewed to understand and evaluate the mechanisms behind each of the hypotheses. Although there is some evidence supporting the depolarization hypothesis, the repolarization hypothesis is more supported by real life studies and models of the syndrome.

show abstract

Section: Repolarization Hypothesissupporting

confidence: 65%

Two hypotheses of Brugada Syndrome – Repolarization and Depolarization: Literature Review

Koo¹,

Hutt²

2021

J Stud Res

View full text Add to dashboard Cite

show abstract

“…Other new non-invasive parameters may be a valuable additional tool for risk stratification. Recent studies evaluated the use of additional ECG/signal-averaged ECG parameters such as fragmented QRS complexes, QRS width, lead aVR sign, early repolarization, late potentials, and T-wave alternans [[7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18]]. Tpeak-to-Tend (TpTe), TpTe/QT ratio, and Tpe Dispersion which are the interest of this systematic review are also touted to have prognostic value for predicting sudden cardiac death [[19], [20], [21]].…”

Section: Introductionmentioning

confidence: 99%

Markers of ventricular repolarization as an additional non-invasive electrocardiography parameters for predicting ventricular tachycardia/fibrillation in patients with Brugada Syndrome – A systematic review and meta-analysis

Pranata

Yonas

Vania

et al. 2019

Indian Pacing and Electrophysiology Journal

View full text Add to dashboard Cite

BackgroundControversies surrounded the management of asymptomatic Brugada syndrome. Prognostication using electrophysiology study (EPS) is disputable. Non-invasive parameters may be a valuable additional tool for risk stratification. We aim to evaluate the use markers of ventricular repolarization including Tpeak-to-Tend (TpTe), Tpe Dispersion, TpTe/QT ratio, and QTc interval as additional non-invasive electrocardiography parameters for predicting ventricular tachycardia/fibrillation in patients with Brugada syndrome.MethodsWe performed a comprehensive search on TpTe, Tpe Dispersion, TpTe/QT ratio, and QTc interval as a predictor for ventricular tachycardia(VT)/fibrillation(VF)/aborted sudden cardiac death/appropriate ICD shock in patients with Brugada syndromes up until October 2018.ResultsWe included ten studies in the qualitative synthesis and eight studies in meta-analysis. There were a total of 2126 subjects from ten studies. We found that TpTe interval (mean difference 11.97 m s [5.02–18.91]; p < 0.001; I2 80% possibly on ≥80–100 m s and maximum QTc interval (mean difference 11.42 m s [5.90–16.93], p < 0.001; I2 28%) were the most potential ECG parameters to predict VT/VF/AT/SCD. Tpe dispersion and TpTe/QT ratio have a high heterogeneity. Upon sensitivity analysis, there is no single study found to markedly affect heterogeneity of Tpe dispersion and TpTe/QT ratio. Removal of a study reduced maximum QTc interval heterogeneity to 0%.ConclusionsMeasurement of TpTe interval, Tp-e dispersion, TpTe/QT ratio, and QTc interval on ECG emerge as a promising prognostication tool which needs further investigations with a more standardized method, outcome, and cut-off points. As for now, only maximum QTc interval has a reliable result with low heterogeneity sufficiently reliable for prognostication.

show abstract

“…APD alternans have been demonstrated in a canine model of BrS (Morita et al, 2006 ). T-wave alternans have also been in Brugada subjects, lending support to the hypothesis that repolarization abnormalities play a role in arrhythmogenesis (Nishizaki et al, 2005 ; Uchimura-Makita et al, 2014 ; Sakamoto et al, 2016 ).…”

Section: Electrophysiological Mechanisms Underlying Arrhythmogenesis mentioning

confidence: 57%

Electrophysiological Mechanisms of Brugada Syndrome: Insights from Pre-clinical and Clinical Studies

Tse

Liu

et al. 2016

Front. Physiol.

View full text Add to dashboard Cite

Brugada syndrome (BrS), is a primary electrical disorder predisposing affected individuals to sudden cardiac death via the development of ventricular tachycardia and fibrillation (VT/VF). Originally, BrS was linked to mutations in the SCN5A, which encodes for the cardiac Na+ channel. To date, variants in 19 genes have been implicated in this condition, with 11, 5, 3, and 1 genes affecting the Na+, K+, Ca2+, and funny currents, respectively. Diagnosis of BrS is based on ECG criteria of coved- or saddle-shaped ST segment elevation and/or T-wave inversion with or without drug challenge. Three hypotheses based on abnormal depolarization, abnormal repolarization, and current-load-mismatch have been put forward to explain the electrophysiological mechanisms responsible for BrS. Evidence from computational modeling, pre-clinical, and clinical studies illustrates that molecular abnormalities found in BrS lead to alterations in excitation wavelength (λ), which ultimately elevates arrhythmic risk. A major challenge for clinicians in managing this condition is the difficulty in predicting the subset of patients who will suffer from life-threatening VT/VF. Several repolarization risk markers have been used thus far, but these neglect the contributions of conduction abnormalities in the form of slowing and dispersion. Indices incorporating both repolarization and conduction and based on the concept of λ have recently been proposed. These may have better predictive values than the existing markers.

show abstract

Utility of T-wave alternans during night time as a predictor for ventricular fibrillation in patients with Brugada syndrome

Cited by 22 publications

References 38 publications

Two hypotheses of Brugada Syndrome – Repolarization and Depolarization: Literature Review

Two hypotheses of Brugada Syndrome – Repolarization and Depolarization: Literature Review

Markers of ventricular repolarization as an additional non-invasive electrocardiography parameters for predicting ventricular tachycardia/fibrillation in patients with Brugada Syndrome – A systematic review and meta-analysis

Electrophysiological Mechanisms of Brugada Syndrome: Insights from Pre-clinical and Clinical Studies

Contact Info

Product

Resources

About