- 作者：Silvia G. Priori ; MD ; PhD?/sup> ; &dagger ; ; &Dagger ; ; silvia.priori@fsm.it ; Maurizio Gasparini ; MD§ ; ; Carlo Napolitano ; MD ; PhD?/sup> ; &Dagger ; ; Paolo Della Bella ; MD?/sup> ; Andrea Ghidini Ottonelli ; MD¶ ; ; Biagio Sassone ; MD# ; Umberto Giordano ; MD?? ; Carlo Pappone ; MD&dagger ; &dagger ; ; Giosuè ; Mascioli ; MD&Dagger ; &Dagger ; ; Guido Rossetti ; MD§ ; § ; ; Roberto De Nardis ; MD¡Î¡Î ; Mario Colombo ; MS¶ ; ¶ ;
- 关键词：Brugada syndrome ; cardiac arrest ; electrophysiology ; risk factors ; ventricular arrhythmias
- 刊名：Journal of the American College of Cardiology
- 出版年：2012
- 出版时间：3 January, 2012
- 年：2012
- 卷：59
- 期：1
- 页码：37-45
- 全文大小：1K
Objectives
The PRELUDE (PRogrammed ELectrical stimUlation preDictive valuE) prospective registry was designed to assess the predictive accuracy of sustained ventricular tachycardia/ventricular fibrillation (VTs/VF) inducibility and to identify additional predictors of arrhythmic events in Brugada syndrome patients without history of VT/VF.Background
Brugada syndrome is a genetic disease associated with increased risk of sudden cardiac death. Even though its value has been questioned, inducibility of VTs/VF is widely used to select candidates to receive a prophylactic implantable defibrillator, and its accuracy has never been addressed in prospective studies with homogeneous enrolling criteria.
Methods
Patients with a spontaneous or drug-induced type I electrocardiogram (ECG) and without history of cardiac arrest were enrolled. The registry included 308 consecutive individuals (247 men, 80 % ; median age 44 years, range 18 to 72 years). Programmed electrical stimulation was performed at enrollment, and patients were followed-up every 6 months.
Results
During a median follow-up of 34 months, 14 arrhythmic events (4.5 % ) occurred (13 appropriate shocks of the implantable defibrillator, and 1 cardiac arrest). Programmed electrical stimulation performed with a uniform and pre-specified protocol induced ventricular tachyarrhythmias in 40 % of patients: arrhythmia inducibility was not a predictor of events at follow-up (9 of 14 events occurred in noninducible patients). History of syncope and spontaneous type I ECG (hazard ratio [HR]: 4.20), ventricular refractory period <200 ms (HR: 3.91), and QRS fragmentation (HR: 4.94) were significant predictors of arrhythmias.
Conclusions
Our data show that VT/VF inducibility is unable to identify high-risk patients, whereas the presence of a spontaneous type I ECG, history of syncope, ventricular effective refractory period <200 ms, and QRS fragmentation seem useful to identify candidates for prophylactic implantable cardioverter defibrillator.