Prognostic Significance of the Sodium Channel Blocker Test in Patients With Brugada Syndrome
BackgroundA drug provocation test using a sodium channel blocker (SCB) can unmask a type 1 ECG pattern in patients with Brugada syndrome. However, the prognostic value of the results of an SCB challenge is limited in patients with non–type 1 ECG. We investigated the associations of future risk for v...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2018-05-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.008617 |
| _version_ | 1818775943379943424 |
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| author | Akira Ueoka Hiroshi Morita Atsuyuki Watanabe Yoshimasa Morimoto Satoshi Kawada Motomi Tachibana Masakazu Miyamoto Koji Nakagawa Nobuhiro Nishii Hiroshi Ito |
| author_facet | Akira Ueoka Hiroshi Morita Atsuyuki Watanabe Yoshimasa Morimoto Satoshi Kawada Motomi Tachibana Masakazu Miyamoto Koji Nakagawa Nobuhiro Nishii Hiroshi Ito |
| author_sort | Akira Ueoka |
| collection | DOAJ |
| description | BackgroundA drug provocation test using a sodium channel blocker (SCB) can unmask a type 1 ECG pattern in patients with Brugada syndrome. However, the prognostic value of the results of an SCB challenge is limited in patients with non–type 1 ECG. We investigated the associations of future risk for ventricular fibrillation with SCB‐induced ECG changes and ventricular tachyarrhythmias (VTAs). Methods and ResultsWe administered intravenous pilsicainide to 245 consecutive patients with Brugada syndrome (181 patients with spontaneous type 1 ECG, 64 patients with non–type 1 ECG). ECG parameters before and after the test and occurrence of drug‐induced VTAs were evaluated. During a mean follow‐up period of 113±57 months, fatal VTA events occurred in 31 patients (sudden death: n=3, ventricular tachycardia/ventricular fibrillation: n=28). Symptomatic patients and spontaneous type 1 ECG were associated with future fatal arrhythmic events. Univariable analysis of ECG parameters after the test showed that long PQ and QRS intervals, high ST level, and SCB‐induced VTAs were associated with later VTA events during follow‐up. Multivariable analysis showed that symptomatic patients, high ST level (V1) ≥0.3 mV after the test, and SCB‐induced VTAs were independent predictors for future fatal arrhythmic events (hazard ratios: 3.28, 2.80, and 3.62, 95% confidence intervals: 1.54–7.47, 1.32–6.35, and 1.64–7.75, respectively; P<0.05). ConclusionsSCB‐induced VTAs and ST‐segment augmentation are associated with an increased risk of the development of ventricular tachycardia/ventricular fibrillation events during follow‐up in patients with Brugada syndrome. |
| first_indexed | 2024-12-18T11:05:04Z |
| format | Article |
| id | doaj.art-83c4bf788c3143d09b941a1492773c90 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-18T11:05:04Z |
| publishDate | 2018-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-83c4bf788c3143d09b941a1492773c902022-12-21T21:10:08ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-05-0171010.1161/JAHA.118.008617Prognostic Significance of the Sodium Channel Blocker Test in Patients With Brugada SyndromeAkira Ueoka0Hiroshi Morita1Atsuyuki Watanabe2Yoshimasa Morimoto3Satoshi Kawada4Motomi Tachibana5Masakazu Miyamoto6Koji Nakagawa7Nobuhiro Nishii8Hiroshi Ito9Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, JapanDepartment of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, JapanDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, JapanDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, JapanDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, JapanDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, JapanDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, JapanDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, JapanDepartment of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, JapanDepartment of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, JapanBackgroundA drug provocation test using a sodium channel blocker (SCB) can unmask a type 1 ECG pattern in patients with Brugada syndrome. However, the prognostic value of the results of an SCB challenge is limited in patients with non–type 1 ECG. We investigated the associations of future risk for ventricular fibrillation with SCB‐induced ECG changes and ventricular tachyarrhythmias (VTAs). Methods and ResultsWe administered intravenous pilsicainide to 245 consecutive patients with Brugada syndrome (181 patients with spontaneous type 1 ECG, 64 patients with non–type 1 ECG). ECG parameters before and after the test and occurrence of drug‐induced VTAs were evaluated. During a mean follow‐up period of 113±57 months, fatal VTA events occurred in 31 patients (sudden death: n=3, ventricular tachycardia/ventricular fibrillation: n=28). Symptomatic patients and spontaneous type 1 ECG were associated with future fatal arrhythmic events. Univariable analysis of ECG parameters after the test showed that long PQ and QRS intervals, high ST level, and SCB‐induced VTAs were associated with later VTA events during follow‐up. Multivariable analysis showed that symptomatic patients, high ST level (V1) ≥0.3 mV after the test, and SCB‐induced VTAs were independent predictors for future fatal arrhythmic events (hazard ratios: 3.28, 2.80, and 3.62, 95% confidence intervals: 1.54–7.47, 1.32–6.35, and 1.64–7.75, respectively; P<0.05). ConclusionsSCB‐induced VTAs and ST‐segment augmentation are associated with an increased risk of the development of ventricular tachycardia/ventricular fibrillation events during follow‐up in patients with Brugada syndrome.https://www.ahajournals.org/doi/10.1161/JAHA.118.008617Brugada syndromerisk stratificationsodium channel blockerventricular fibrillation |
| spellingShingle | Akira Ueoka Hiroshi Morita Atsuyuki Watanabe Yoshimasa Morimoto Satoshi Kawada Motomi Tachibana Masakazu Miyamoto Koji Nakagawa Nobuhiro Nishii Hiroshi Ito Prognostic Significance of the Sodium Channel Blocker Test in Patients With Brugada Syndrome Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease Brugada syndrome risk stratification sodium channel blocker ventricular fibrillation |
| title | Prognostic Significance of the Sodium Channel Blocker Test in Patients With Brugada Syndrome |
| title_full | Prognostic Significance of the Sodium Channel Blocker Test in Patients With Brugada Syndrome |
| title_fullStr | Prognostic Significance of the Sodium Channel Blocker Test in Patients With Brugada Syndrome |
| title_full_unstemmed | Prognostic Significance of the Sodium Channel Blocker Test in Patients With Brugada Syndrome |
| title_short | Prognostic Significance of the Sodium Channel Blocker Test in Patients With Brugada Syndrome |
| title_sort | prognostic significance of the sodium channel blocker test in patients with brugada syndrome |
| topic | Brugada syndrome risk stratification sodium channel blocker ventricular fibrillation |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.008617 |
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