Brugada Sendromu Hastalarında Repolarizasyon Parametrelerinin Klinik Önemi

GİRİŞ ve AMAÇ: Brugada Sendromu (BS) ani ölüm riskinin arttığı kalıtsal bir hastalıktır. Mevcut risk parametreleri yetersizdir. Artmış T dalga alternansı (TDA) ve uzamış T dalgası pik-son süresi (Tp-e) ani kardiyak ölüm ile ilişkilidir. Bu çalışmada TDA ve Tp-e süresinin BS hastalarındaki rolü araştırılmıştır YÖNTEM ve GEREÇLER: Çalışmaya 13 BS hastası ve 11 kontrol alınmıştır. BS ve kontrollerde TDA ve EKG kaydedilmiştir. Hastalar ve kontroler ventriküler aritmi açısından takip edilmiştir. BULGULAR: BS ve kontrollerde TDA negatif saptanmıştır. Ancak BS hastalarında Tp-e süresi kontrollere göre daha uzun saptanmıştır. Ayrıca takipte ventriküler aritmi gelişen hastaların tümünde Tp-e 100 ms' nin üzerindedir. TARTIŞMA ve SONUÇ: BS hastalarında TDA uygun olmayan bir testtir, Tp-e süresinin uzaması BS hastalarında artmış risk ile ilişkili olabilir.

Clinical Significance of Repolarization Parameters in Brugada Syndrome Patients

INTRODUCTION: Brugada syndrome (BS) is a genetic disease with increased risk of sudden cardiac death. Increased T wave alternans (TWA) and prolonged T wave peak to end (Tp-e) interval are linked to sudden cardiac death. In the present study, we investigated the role of TWA and Tp-e interval in BS. METHODS: Thirteen BS and 11 controls were included. TWA and ECG were recorded. Patients and controls were followed for ventricular arrhythmias. RESULTS: TWA study was negative in BS and controls. Tp-e interval was longer in BS than controls. Furthermore, during f/u all patients with ventricular arrhythmiashad Tp-e interval longer than 100 ms DISCUSSION and CONCLUSION: TWA is an inappropriate test for BS, prolonger Tpe may be related to increased risk in BS patients

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  • 1. Antzelevitch C, Brugada P, Borggrefe M, et al. Brugada syndrome: report of the second consensus conference: endorsed by the Heart Rhythm Society and the European Heart Rhythm Association. Circulation 2005; 111: 659-70.
  • 2. Meregalli PG, Wilde AA, Tan HL. Pathophysiological mechanisms of Brugada syndrome: Depolarization disorder, repolarization disorder, or more? Cardiovasc Res 2005;67: 367- 78.
  • 3. Delise P, Allocca G, Marras E, et al. Risk stratification in individuals with the Brugada type 1 ECG pattern without previous cardiac arrest: usefulness of a combined clinical and electrophysiologic approach. Eur Heart J 2011; 32: 169-76.
  • 4. Raju H, Papadakis M, Govindan M, et al. Low prevelance of risk markers in cases of sudden death due to Brugada Syndrome relevance to risk stratification in Brugada syndrome. J Am Coll Cardiol 2011; 57: 2340-5.
  • 5. Gold MR, Ip JH, Costantini O, et al. Role of micro- volt T-wave alternans in assessment of arrhythmia vulnerability among patients with heart failure and systolic dysfunction: primary results from the T-wave alternans sudden cardiac death in heart failure trial substudy. Circulation 2008;118:2022 – 8.
  • 6. Cox V, Patel M, Kim J, et al. Predicting arrhythmia-free survival using spectral and modified moving average analysis of T-wave alternans. Pacing Clin Electrophysiol 2007;30:352- 8.
  • 7. Nearing BD, Verrier RL. Modified moving average analysis of T-wave alternans to predict ventricular fibrillation with high accuracy. J Appl Physiol 2002;92:541–9.
  • 8. Nieminen T, Lehtima ki T, Viik J, et al. Twave alternans predicts mortality in a population undergoing a clinically indicated exercise test. Eur Heart J 2007;2:2332–7.
  • 9. Exner DV, Kavanagh KM, Slawnych MP, et al. Noninvasive risk assessment early after a myocardial infarction the REFINE study. J Am Coll Cardiol 2007;50:2275–84.
  • 10. Gehi AK, Stein RH, Metz LD, Gomes JA. Microvolt T wave alternans for the risk statification of ventricular tachyarrhythmic events: a metaanalysis. J AM Coll Cardiol 2005;46:75–82.
  • 11. Ikeda T, Yoshino H, Sugi K, et al. Predictive value of microvolt T wave alternans for sudden cardiac death in patients with preserved cardiac function after acute myocardial infarction: results of a collaborative cohort study. J Am Coll Cardiol 2006;48:2268 – 74.
  • 12. Nishizaki M, Fujii H, Sakurada H, et al. Spontaneous T wave alternans in a patient with brugada syndrome-responses to intravenous administration of class I antiarrhythmic drug, glucose tolerance test, and atrial pacing. J Cardiovasc Electrophysiol 2005;16:217–220.
  • 13. Tada H, Nogami A, Shimizu W, et al. ST segment and T wave alternans in a patient with Brugada syndrome. PACE 2000;23:413–415.
  • 14. Chinushi M, Washizuka T, Okumura H, Aizawa Y. Intravenous administration of class I antiarrhythmic drugs induced T wave alternans in a patient with Brugada syndrome. J Cardiovasc Electrophysiol 2001;12:493–495.
  • 15. Chinushi Y, Chinushi M, Toida T, Aizawa Y. Class I antiarrhythmic drug and coronary vasospasm- induced T wave alternans and ventricular tachyarrhythmia in a patient with Brugada syndrome and vasospastic angina. J Cardiovasc Electrophysiol 2002;13:191–194.
  • 16. Takagi M, Doi A, Takeuchi K, Yoshikawa J. Pilsicanide-induced marked T wave alternans and ventricular fibrillation in a patient with Brugada syndrome. J Cardiovasc Electrophysiol 2002;13:837.
  • 17. Ohkubo K, Watanabe I, Okumura Y, Yamada T, Masaki R, Kofune T, Oshikawa N, Kasamaki Y, Saito S, Ozawa Y, Kanmatsuse K. Intravenous administration of class I antiarrhythmic drug induced T wave alternans in an asymptomatic Brugada syndrome patient. PACE 2003;26:1900– 1903.
  • 18. Morita H, Morita ST, Nagase S, et al. Ventricular arrhythmia induced by sodium channel blocker in patients with Brugada syndrome. J Am Coll Cardiol 2003;42:1624–1631.
  • 19. Morita H, Nagase S, Kusano K, Ohe T. Spontaneous T wave alternans and premature ventricular contractions during febrile illness in a patient with Brugada syndrome. J Cardiovasc Electrophysiol 2002;13:816–818.
  • 20. Kors JA, Ritsema van Eck HJ, van Herpen G. The meaning of the Tp- Te interval and its diagnostic value. J Electrocardiol 2008; 41:575– 580.
  • 21. Shimizu M, Ino H, Okeie K, et al. T-peak to T-end interval may be a better predictor of high-risk patients with hypertrophic cardiomyopathy associated with a cardiac troponin I mutation than QT dispersion. Clin Cardiol 2002; 25:335–339.
  • 22. Haarmark C, Hansen PR, Vedel-Larsen E, et al. The prognostic value of the Tpeak-Tend interval in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. J Electrocardiol 2009; 42:555–560.
  • 23. Castro Hevia J, Antzelevitch C, Tornés Bárzaga F, et al. Tpeak-Tend and Tpeak-Tend dispersion as risk factors for ventricular tachycardia/ventricular fibrillation in patients with the Brugada syndrome. J Am Coll Cardiol. 2006 May 2;47(9):1828-34
  • 24. Yalin K, Golcuk E, Teker E, Bilge AK, Adalet K. Is there a role of MMA T wave alternans for risk assessment in Brugada Syndrome? Anadolu Kardiyol Derg. 2013;13:702-704
  • 25. Tada T, Kusano KF, Nagase S, et al. Clinical significance of macroscopic T-wave alternans after sodium channel blocker administration in patients with Brugada Syndrome. J Cardiovasc Electrophysiol 2008;19:56-61.
  • 26. Uchimura-Makita Y, Nakano Y, Sairaku A, et al. Time-domain T-wave alternans in lead V2 is useful for predicting ventricular arrhythmias in patients with Brugada Syndrome [abstract]. Circulation 2013; 128: A16522.
  • 27. Kirchhof P, Eckardt L, Rolf S, et al.T-wave alternans dose not assess arrhythmic risk in patients with Brugada syndrome. Ann Noninvasive Electrocardiol 2004;9:162-165.
  • 28. Verrier RL. Comment on ”Is there a role of MMA T wave alternans for risk assessment in Brugada Syndrome?” Anadolu Kardiyol Derg. 2014;14:96
  • 29. Sakamoto S, Takagi M, Tatsumi H, et al. Utility of T-wave alternans during night time as a predictor for ventricular fibrillation in patients with Brugada syndrome. Heart Vessels. 2016 Jun;31(6):947-56
  • 30. Brugada J, Pappone C, Berruezo A, et al. Brugada Syndrome Phenotype Elimination by Epicardial Substrate Ablation. Circ Arrhythm Electrophysiol. 2015 Dec;8(6):1373-81.