A spontaneous Type 1 electrocardiogram pattern in lead V2 is an independent predictor of ventricular fibrillation in Brugada syndrome

• Published in: Europace (London, England) Vol. 12; no. 3; pp. 410 - 416
• Main Authors: Nakano, Yukiko, Shimizu, Wataru, Ogi, Hiroshi, Suenari, Kazuyoshi, Oda, Noboru, Makita, Yuko, Kajihara, Kenta, Hirai, Yukoh, Sairaku, Akinori, Tokuyama, Takehito, Tonouchi, Yukiji, Ueda, Shigeyuki, Sueda, Taijiro, Chayama, Kazuaki, Kihara, Yasuki
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-03-2010
• Subjects: Adult; Brugada Syndrome - diagnosis; Brugada Syndrome - epidemiology; Brugada Syndrome - genetics; Death, Sudden, Cardiac - epidemiology; Death, Sudden, Cardiac - prevention & control; Defibrillators, Implantable; Disease-Free Survival; Electrocardiography; Female; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Middle Aged; Multivariate Analysis; Muscle Proteins - genetics; NAV1.5 Voltage-Gated Sodium Channel; Predictive Value of Tests; Prospective Studies; Retrospective Studies; Risk Factors; Sodium Channels - genetics; Ventricular Fibrillation - diagnosis; Ventricular Fibrillation - epidemiology; Ventricular Fibrillation - therapy; SCN5A; Brugada syndrome; Atrial fibrillation; Sudden death; Risk stratification; Ventricular fibrillation
• DOI: 10.1093/europace/eup446
• EISSN: 1532-2092
• ISSN: 1099-5129

Aim
Risk stratification for Brugada syndrome remains controversial. We investigated the relationships between episodes of ventricular fibrillation (VF) and various clinical, electrocardiographic, electrophysiologic, and genetic parameters both retrospectively and prospectively.
Methods and results
Fifty-two patients with Brugada syndrome (49 men, average age 42 ± 3 years) were studied. In the Brugada patients with a VF history, the frequency of a spontaneous Type 1 electrocardiogram (ECG) pattern in lead V2 was significantly higher and the STJ amplitude in the V1 and V2 leads was also higher than in those without a VF history. Multivariate analyses revealed that the spontaneous Type 1 ECG pattern in lead V2 (but not lead V1) was the only independent predictor of a VF history. During a mean follow-up period of 39 ± 4 months, 38.8% of the patients with a VF history and 2.9% of those without experienced an appropriate implantable cardioverter-defibrillation owing to VF. A multivariate analysis using a Cox's proportional hazard model showed that a VF history and spontaneous Type 1 ECG pattern in lead V2 were independent predictors of subsequent VF events.
Conclusion
A spontaneous Type 1 Brugada ECG pattern in lead V2 (but not lead V1) was both a prospective and retrospective independent predictor of VF episodes in Brugada syndrome.