Background: Risk stratification in asymptomatic patients remains by far the most important yet unresolved clinical problem in the Brugada syndrome (BrS).
Objectives: This study sought to analyze the usefulness of electrocardiographic parameters as markers of sudden cardiac death (SCD) in BrS.
Methods: This study analyzed data from 347 consecutive patients (78.4% male; mean age 45 ± 13.1 years) with spontaneous type 1 BrS by ECG parameters but with no history of cardiac arrest (including 91.1% asymptomatic at presentation, 5.2% with a history of atrial fibrillation [AF], and 4% with a history of arrhythmic syncope). Electrocardiographic characteristics at the first clinic visit were analyzed to predict ventricular fibrillation (VF)/SCD during follow-up.
Results: During the follow-up (48 ± 38 months), 276 (79.5%) patients remained asymptomatic, 39 (11.2%) developed syncope, and 32 (9.2%) developed VF/SCD. Patients who developed VF/SCD had a lower prevalence of SCN5A gene mutations (p = 0.009) and a higher prevalence of positive electrophysiological study results (p < 0.0001), a family history of SCD (p = 0.03), and AF (p < 0.0001). The most powerful marker for VF/SCD was a significant S-wave (≥0.1 mV and/or ≥40 ms) in lead I. In the multivariate analysis, the duration of S-wave in lead I ≥40 ms (hazard ratio: 39.1) and AF (hazard ratio: 3.7) were independent predictors of VF/SCD during follow-up. Electroanatomic mapping in 12 patients showed an endocardial activation time significantly longer in patients with an S-wave in lead I, mostly because of a significant delay in the anterolateral right ventricular outflow tract.
Conclusions: The presence of a wide and/or large S-wave in lead I was a powerful predictor of life-threatening ventricular arrhythmias in patients with BrS and no history of cardiac arrest at presentation. However, the prognostic value of a significant S-wave in lead I should be confirmed by larger studies and by an independent confirmation cohort of healthy subjects.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.jacc.2016.01.024 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Exploring the Accuracy of Interferometric Quantum Measurements under Conservation Laws.
Phys Rev Lett
December 2024
MajuLab, CNRS-UCA-SU-NUS-NTU International Joint Research Laboratory.
A (target) quantum system is often measured through observations performed on a second (meter) system to which the target is coupled. In the presence of global conservation laws holding on the joint meter-target system, the Wigner-Araki-Yanase theorem and its generalizations predict a lower bound on the measurement's error (Ozawa's bound). While practically negligible for macroscopic meters, it becomes relevant for microscopic ones.
View Article and Find Full Text PDFElectrocardiographic changes in severe quetiapine poisoning.
Clin Toxicol (Phila)
December 2024
Department of Forensic Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan.
Introduction: Quetiapine shares sodium channel-blocking properties with tricyclic antidepressants. We present the electrographic findings in two patients with severe quetiapine poisoning.
Case Summaries: Two patients poisoned with quetiapine presented with impaired consciousness, requiring mechanical ventilation and vasopressor support, with one also experiencing status epilepticus.
Machine learning to classify left ventricular hypertrophy using ECG feature extraction by variational autoencoder.
medRxiv
October 2024
Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, Kansas.
Background: Traditional ECG criteria for left ventricular hypertrophy (LVH) have low diagnostic yield. Machine learning (ML) can improve ECG classification.
Methods: ECG summary features (rate, intervals, axis), R-wave, S-wave and overall-QRS amplitudes, and QRS/QRST voltage-time integrals (VTIs) were extracted from 12-lead, vectorcardiographic X-Y-Z-lead, and root-mean-square (3D) representative-beat ECGs.
Modified torso vs distal limb electrode placement for performing ECGs in children: A method comparison study.
J Electrocardiol
December 2024
Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Background: The electrocardiogram (ECG) is routinely performed in children with the limb electrodes positioned on the torso, but few studies have investigated the effects of this modification on the pediatric ECG. Our objective was to assess the agreement between the standard limb lead configuration and a modified torso electrode configuration in normal, healthy children, and to assess the effect of height on that agreement.
Methods: 185 children aged 5-18 years underwent two consecutive 12‑lead ECGs, one with standard distal limb lead placement and one with the limb leads placed on the torso.
Phenotype of severe tricuspid regurgitation induced by intracardiac pacing devices.
Med Clin (Barc)
January 2025
Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, España.
Introduction And Aims: Tricuspid regurgitation (TR) induced by the implantation of cardiac implantable electronic devices (CIED) is an increasingly common cause of severe TR. Our aim was to describe the echocardiographic phenotypic characteristics of CIED-induced severe TR.
Methods: Retrospective cohort study that included patients with severe TR related to CIED diagnosed in the cardiac imaging unit of a Spanish tertiary hospital.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!