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Assessment of Markers for Identifying Patients at Risk for Life‐Threatening Arrhythmic Events in Brugada Syndrome

2005; Wiley; Volume: 16; Issue: 1 Linguagem: Inglês

10.1046/j.1540-8167.2005.04313.x

1540-8167

Youichi Ajiro, Nobuhisa Hagiwara, Hiroshi Kasanuki,

Ion channel regulation and function

Introduction: Risk stratification for life‐threatening arrhythmic events in Brugada syndrome is not yet established. The aim of the present study was to examine the usefulness of various markers in predicting life‐threatening arrhythmic events in the Brugada syndrome. Methods and Results: Forty‐six patients with Brugada‐type ECGs were categorized into the symptomatic (n = 28) and asymptomatic (n = 18) groups. Statistical analyses were performed with respect to the usefulness of the following markers: SCN5A mutation, pharmacologic challenge, ventricular fibrillation (VF) inducibility by programmed electrical stimulation, and late potential (LP) by signal‐averaged ECG (SAECG). Comparison between the two groups revealed a significant difference only in LP positivity (92.6% vs 47.1%, P = 0.0004). The symptomatic group had significantly lower RMS40, longer LAS40, and longer fQRSd compared with the asymptomatic group. A significant difference was noted, especially RMS40. The positive predictive value, negative predictive value, and predictive accuracy when setting a cutoff value of 15 μV were 92.0%, 78.9%, and 86.4%, respectively. Furthermore, patients with an RMS40 value <15 μV (n = 25) showed significantly higher rates of VF recurrence compared with patients with an RMS40 value ≥ 15 μV (n = 19, P = 0.047). Conclusion: Regarding risk stratification for identifying high‐risk patients in Brugada syndrome, only LP by SAECG was shown to be useful, suggesting the importance of RMS40 in predicting the history of life‐threatening arrhythmic events and the recurrence of VF.