Predictors of Ventricular Arrhythmias and Sudden Death in a Québec Cohort With Brugada Syndrome

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• 作者：Lena Rivard ; MD ; MSc^a ; ^{lena.rivard@umontreal.ca" class="auth_mail" title="E-mail the corresponding author} ; Antoine Roux ; MD^b ; Isabelle Nault ; MD^b ; Jean Champagne ; MD^b ; Jean-Franç ; ois Roux ; MD^c ; Rafik Tadros ; MD ; PhD^a ; Mario Talajic ; MD^a ; Julia Cadrin-Tourigny ; MD ; MSc^a ; Azadeh Shohoudi ; PhD^d ; Blandine Mondé ; sert ; MD^a ; Denis Roy ; MD^a ; Laurent Macle ; MD^a ; Jason Andrade ; MD^a ; Katia Dyrda ; MD^a ; Marc Dubuc ; MD^a ; Peter G. Guerra ; MD^a ; Jean-Franç ; ois Sarrazin ; MD^b ; Bernard Thibault ; MD^a ; Paul Khairy ; MD ; PhD^a ; ^d
• 刊名：Canadian Journal of Cardiology
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：32
• 期：11
• 页码：1355.e1-1355.e7
• 全文大小：469 K

文摘

Patients with Brugada syndrome (BrS) are at risk for ventricular arrhythmias (VAs) and sudden death. Identification of high-risk individuals beyond those with syncope or resuscitated sudden death remains a major challenge.

Methods

We assessed the value of clinical, electrophysiological, and electrocardiographic (ECG) features, including depolarization and repolarization metrics, in predicting arrhythmic events and sudden death in consecutive patients with BrS diagnosed between 2002 and 2013 in Quebec, Canada. Qualifying electrocardiograms with the highest type 1 ST-segment elevations were reviewed and analyzed by 2 electrophysiologists who were blinded to clinical history. Survival analyses were adjusted for Firth bias correction and left truncation.

Results

A total of 105 patients, 79.8% of whom were men, were diagnosed with BrS at a mean age of 46.2 ± 13.3 years and were followed for 59.6 ± 16.4 months. Ten (9.5%) had a history of cardiac arrest, 37 (35.2%) had syncope, and 7 (6.7%) experienced 20 arrhythmic events during follow-up, all consisting of appropriate ICD therapy (7 antitachycardia pacing; 13 shocks). In multivariate Cox regression analyses, a spontaneous type 1 electrocardiographic (ECG) pattern (hazard ratio [HR], 10.80; 95% confidence interval [CI], 1.03-113.87; P = 0.0476), maximal T peak-end (T_p-e) duration ≥ 100 ms (HR, 29.73; 95% CI, 1.33-666.37; P = 0.0325), and QRS duration in lead V₆ > 110 ms (HR, 15.27; 95% CI, 1.07-217.42; P = 0.0443) were independently associated with VAs or aborted sudden cardiac death.

Conclusions

In a multicentre cohort with BrS from Quebec, Canada, VAs and sudden death were independently associated with standard 12-lead ECG features, including a spontaneous type 1 pattern, depolarization (QRS in lead V₆), and repolarization (maximal T_p-e duration) criteria.