Mode of onset of ventricular fibrillation in patients with early repolarization pattern vs. Brugada syndrome

• Published in: European heart journal Vol. 31; no. 3; pp. 330 - 339
• Main Authors: Nam, Gi-Byoung, Ko, Kwan-Ho, Kim, Jun, Park, Kyoung-Min, Rhee, Kyoung-Suk, Choi, Kee-Joon, Kim, You-Ho, Antzelevitch, Charles
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-02-2010
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Brugada Syndrome - complications; Brugada Syndrome - therapy; Cardiac dysrhythmias; Cardiac Pacing, Artificial; Cardiology. Vascular system; Cardiotonic Agents - therapeutic use; Case-Control Studies; Clinical Research; Electrical storm; Electrocardiography; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Female; Heart; Humans; Intensive care medicine; Isoproterenol - therapeutic use; J waves; Male; Medical sciences; Middle Aged; Sudden cardiac death; Ventricular fibrillation; Ventricular Fibrillation - etiology; Ventricular Fibrillation - therapy; Young Adult; Electrocardiography; Electrical storm; Sudden cardiac death; J waves; Ventricular fibrillation; Human; Repolarization; Arrhythmia; Brugada syndrome; Sudden death; Cardiovascular disease; Patient; Excitability disorder; Wave; Electrodiagnosis; Heart disease; Early; Circulatory system; Cardiology; Comparative study
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehp423

Aims The aim of the present study was to identify specific electrocardiogram (ECG) features that predict the development of multiple episodes of ventricular fibrillation (VF) in patients with an early repolarization (ER) pattern and to compare the mode of VF initiation with that observed in typical cases of Brugada syndrome (BrS). Methods and results The mode of the onset and the coupling intervals of the premature ventricular contractions (PVCs) initiating VF episodes were analysed in patients with BrS (n = 8) or ER who experienced sudden cardiac death/syncope or repeated appropriate implantable cardioverter defibrillator shocks. Among the 11 patients with ER, 5 presented with electrical storm (ES, four or more recurrent VF episodes/day). The five ES patients displayed a dramatic but very transient accentuation of J waves across the precordial and limb leads prior to the development of ES. Ventricular fibrillation episodes were more commonly initiated by PVCs with a short–long–short (SLS) sequence in ER (42/58, 72.4%) vs. BrS patients (13/86, 15.1%, P < 0.01). Coupling intervals were significantly shorter in the ER group compared with those with BrS [328 (320, 340) ms vs. 395 (350, 404) ms, P < 0.01]. Conclusion Our study provides additional evidence in support of the hypothesis that ER pattern in the ECG is not always benign. Transient augmentation of global J waves may be indicative of a highly arrhythmogenic substrate heralding multiple episodes of VF in patients with ER pattern. Ventricular tachycardia/VF initiation is more commonly associated with an SLS sequence, and PVCs display a shorter coupling interval in patients with ER pattern compared with those with BrS.