scholarly journals Tpeak-Tend and Tpeak-Tend Dispersion as Risk Factors for Ventricular Tachycardia/Ventricular Fibrillation in Patients With the Brugada Syndrome

2006 ◽  
Vol 47 (9) ◽  
pp. 1828-1834 ◽  
Author(s):  
Jesus Castro Hevia ◽  
Charles Antzelevitch ◽  
Francisco Tornés Bárzaga ◽  
Margarita Dorantes Sánchez ◽  
Francisco Dorticós Balea ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ventricular Tachycardia ◽  
Ventricular Fibrillation ◽  
Brugada Syndrome

scholarly journals Incorporating Latent Variables Using Nonnegative Matrix Factorization Improves Risk Stratification in Brugada Syndrome

2020 ◽  
Vol 9 (22) ◽  
Author(s):  
Gary Tse ◽  
Jiandong Zhou ◽  
Sharen Lee ◽  
Tong Liu ◽  
George Bazoukis ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ventricular Tachycardia ◽  
Ventricular Fibrillation ◽  
Risk Stratification ◽  
Matrix Factorization ◽  
Brugada Syndrome ◽  
Latent Variables ◽  
Odds Ratio ◽  
Nonnegative Matrix Factorization ◽  
Nonnegative Matrix

Background A combination of clinical and electrocardiographic risk factors is used for risk stratification in Brugada syndrome. In this study, we tested the hypothesis that the incorporation of latent variables between variables using nonnegative matrix factorization can improve risk stratification compared with logistic regression. Methods and Results This was a retrospective cohort study of patients presented with Brugada electrocardiographic patterns between 2000 and 2016 from Hong Kong, China. The primary outcome was spontaneous ventricular tachycardia/ventricular fibrillation. The external validation cohort included patients from 3 countries. A total of 149 patients with Brugada syndrome (84% males, median age of presentation 50 [38–61] years) were included. Compared with the nonarrhythmic group (n=117, 79%), the spontaneous ventricular tachycardia/ ventricular fibrillation group (n=32, 21%) were more likely to suffer from syncope (69% versus 37%, P =0.001) and atrial fibrillation (16% versus 4%, P =0.023) as well as displayed longer QTc intervals (424 [399–449] versus 408 [386–425]; P =0.020). No difference in QRS interval was observed (108 [98–114] versus 102 [95–110], P =0.104). Logistic regression found that syncope (odds ratio, 3.79; 95% CI, 1.64–8.74; P =0.002), atrial fibrillation (odds ratio, 4.15; 95% CI, 1.12–15.36; P =0.033), QRS duration (odds ratio, 1.03; 95% CI, 1.002–1.06; P =0.037) and QTc interval (odds ratio, 1.02; 95% CI, 1.01–1.03; P =0.009) were significant predictors of spontaneous ventricular tachycardia/ventricular fibrillation. Increasing the number of latent variables of these electrocardiographic indices incorporated from n=0 (logistic regression) to n=6 by nonnegative matrix factorization improved the area under the curve of the receiving operating characteristics curve from 0.71 to 0.80. The model improves area under the curve of external validation cohort (n=227) from 0.64 to 0.71. Conclusions Nonnegative matrix factorization improves the predictive performance of arrhythmic outcomes by extracting latent features between different variables.

scholarly journals Brugada syndrome: A brand new case

2009 ◽  
Vol 66 (8) ◽  
pp. 667-670
Author(s):  
Ruzica Jurcevic ◽  
Lazar Angelkov ◽  
Dejan Vukajlovic ◽  
Velibor Ristic ◽  
Milosav Tomovic ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Ventricular Fibrillation ◽  
Brugada Syndrome ◽  
Electrophysiological Study ◽  
Structural Heart Disease ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Type I ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation

Background: Brugada syndrome (BS) is a disorder characterized by syncope or sudden death associated with one of several electrocardiographic (ECG) patterns characterized by incomplete right bundle branch block and ST elevation in the anterior precordial leads. Patients with BS are prone to develop ventricular tachyarrhythmias that may lead to syncope, cardiac arrest, or sudden cardiac death. Case report. A 58-year-old woman is the first described case of Brugada syndrome in Serbia with intermittent typical changes in basic electrocardiography (ECG): ST segment elevation in the precordial chest leads like dome or coved - major form or type I. For the last 27 years the patient had suffered of palpitations and dizziness, without syncopal events. Her sister had died suddenly during the night in sleep. During 24-hour Holter monitoring the patient had ventricular premature beats during the night with R/T phenomenon and during the recovery phase of exercise testing had rare premature ventricular beats as the consequence of parasympatethic stimulation. Late potentials were positive. Echocardiography revealed left ventricular ejection fraction of 60%. We performed coronary angiography and epicardial coronary arteries were without significant stenosis and structural heart disease was excluded. In the bigining of the electrophysiological study ECG was normal, and after administration of Propaphenon i.v. Brugada syndrome unmasked with appearance of type I ECG pattern. A programed ventricular stimulation induced non sustained ventricular tachycardia. One-chamber implantable cardioverter defibrillator was implanted and the patient was treated with a combination od amiodarone and metoprolol per os. After one-year follow-up, there were no episodes of ventricular tachycardia and ventricular fibrillation. Conclusion. Brugada syndrome is a myocardial disorder which prognosis and therapy are related to presence of ventricular fibrillation or ventricular tachycardia. Electrophysiologicaly induced malignant ventricular disorders class I are indication for implantation of cardioverter defibrilator, as also occurred in presented patient.

P947dST-Tiso index, a new shallow ECG marker in response to ajmaline for predicting ventricular fibrillation induction in Brugada patients

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
S Iacopino ◽  
P Sorrenti ◽  
G Fabiano ◽  
G Campagna ◽  
A Petretta ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ventricular Fibrillation ◽  
Brugada Syndrome ◽  
Drug Induced ◽  
Non Invasive ◽  
T Wave ◽  
First Case ◽  
Potential Risk Factors

Abstract Introduction - No study has been performed to investigate the role of drug-induced ECG morphology modifications as potential risk factors for the development of malignant arrhythmias in patients with Brugada syndrome. Purpose - The aim of this study is to introduce a new index to improve asymptomatic patient stratification  and to report the first case of a patient with Brugada syndrome undergoing ajmaline testing that has been evaluated using a diagnostic 252-lead ECG vest. Methods - From December 2018 to April 2019, 26 consecutive patients [mean age 39.9 (30–59) years, 18 male] with no cardiovascular risk factors underwent ajmaline testing. By evaluating ECG recordings after ajmaline administration, we calculated an index that we called "dST-Tiso", that is the duration of the positive component of the ST-T wave to the isoelectric line, in V1 and/or V2. Results- Out of 26 patients, 16 (61.5%) had a positive test, with type 1 (coved-type) ECG diagnostic pattern in leads V1-V2 from the 2nd, 3rd and 4th intercostal spaces.  The mean recorded dST-Tiso value was 239 ± 76 ms. The ECG showed T-wave above the isoelectric line in 5 patients with a significantly higher dST-Tiso value (on average 360 ± 56 ms), and biphasic T-waves below the isoelectric line in 11 patients with a dST-Tiso value of 209 ± 42 ms (Mann-Whitney, p = 0.039). All patients with positive ajmaline test underwent programmed electrical stimulation (PES). Ventricular fibrillation was induced during PES in all 5 patients with stretched dST-Tiso. In the remaining 11 patients without stretched dST-Tiso, no ventricular arrhythmia was induced by PES.  Fig 1 Moreover, using non-invasive high-density electrocardiographic mapping (252-lead ECG vest), 3 patients with dST-Tiso positive pattern received a second ajmaline protocol, with assessment of both the depolarization and repolarization phases. Conclusion - The ECG pattern of prolonged dST-Tiso seems to have a significant impact on safety during PES and may have potential for stratifying risk of sudden death in patients with PES-induced ventricular tachycardia/fibrillation. Abstract Figure 1. Patients’ flowchart.

scholarly journals Genetic risk factors for dilated cardiomyopathy

2021 ◽  
Vol 26 (10) ◽  
pp. 4628
Author(s):  
T. G. Vaikhanskaya ◽  
L. N. Sivitskaya ◽  
O. D. Levdansky ◽  
T. V. Kurushko ◽  
N. G. Danilenko
Keyword(s):  
Risk Factors ◽  
Ventricular Tachycardia ◽  
Ventricular Fibrillation ◽  
Dilated Cardiomyopathy ◽  
Left Ventricular ◽  
Sustained Ventricular Tachycardia ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Life Threatening

Aim. To study the diagnostic significance of genetic testing in patients with dilated cardiomyopathy (DCM), identify predictors of life-threatening ventricular tachyarrhythmias (VTAs) and assess adverse clinical outcomes in different genetic groups.Material and methods. The study included 126 unrelated patients with verified DCM as follows: 70 (55,6%) probands with criteria for familial DCM and 56 (44,4%) individuals with a probable hereditary component. All patients (age, 43,1±11,3 years; men, 92 (73%); left ventricular ejection fraction, 30,6±8,43%; left ventricular enddiastolic diameter, 68,3±8,36 mm; follow-up period — median, 49 months) receive a complex of diagnostic investigations, including genetic screening using nextgeneration sequencing, followed by verification of variants by the Sanger method.Results. Pathogenic and likely pathogenic genetic variants were found in 61 (48,4%) of 126 patients with DCM. The dominant mutations were titin-truncating variants (TTNtvs), identified in 16 individuals (12,7%), and variants of lamin A/C (LMNA), identified in 13 probands (10,3%). Mutations in the other 19 genes were found in 32 (25,4%) patients. The following primary endpoints were assessed: sudden cardiac death (SCD), episodes of VTA (sustained ventricular tachycardia/ventricular fibrillation) and appropriate shocks of implanted cardiac resynchronization therapy (CRT)/cardioverter defibrillators (CVD) devices. As a result of ROC analysis, the following independent risk factors for SCD were identified: mutations in the LMNA gene (AUC, 0,760; p=0,0001) and non-sustained ventricular tachycardia (cut-off heart rate ≥161 bpm: AUC, 0,788; p=0,0001). When comparing the phenotypes and genotypes of DCM, TTNtv genotype was associated with a lower prevalence of complete left bundle branch block (χ2=7,46; p=0,024), a lower need for CRT/CVD implantation (χ2=5,70; p=0,017) and more rare episodes of sustained ventricular tachycardia/ventricular fibrillation (χ2=30,1; p=0,0001) compared with LMNA carriers. Kaplan-Meier analysis showed the worst prognosis in carriers of LMNA mutations both in relation to life-threatening VTA (log rang χ2=88,5; p=0,0001) and in achieving all unfavorable outcomes (χ2=27,8; p=0,0001) compared with groups of genenegative individuals, carriers of TTNtv and other genotypes.Conclusion. The phenotypes of DCM with TTNtv did not significantly differ in the incidence of VTAs and adverse outcomes compared with the gene-negative group and other genotypes (with the exception of LMNA). The contribution of the associations of LMNA mutations with VTAs on prognosis was confirmed, which shows the important role of LMNA genotype diagnosis for SCD risk stratification in patients with DCM.

scholarly journals An Open Invitation to Join the International Brugada Electrocardiographic Indices Registry

2020 ◽  
Vol 4 (3) ◽  
pp. 217-221
Author(s):  
Gary Tse ◽  
Sharen Lee ◽  
Xuan Jiang ◽  
Dong Chang ◽  
Yunfei Gu ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Ventricular Fibrillation ◽  
Risk Stratification ◽  
Brugada Syndrome ◽  
Additional Information ◽  
Data Registry ◽  
Asymptomatic Patients ◽  
Baseline Characteristics ◽  
Electrocardiogram Ecg ◽  
Repolarization Abnormalities

Background: The Brugada Electrocardiographic Indices Registry is a comprehensive data registry composed of patients with Brugada patterns on the electrocardiogram (ECG). The aim is to test the hypotheses that (i) ECG indices combining both depolarization and repolarization abnormalities can better predict spontaneous ventricular arrhythmias than existing ECG markers in Brugada syndrome and (ii) that serial ECG measurements will provide additional information for risk stratification, especially in asymptomatic patients.Methods: Patients with both Brugada pattern ECGs and Brugada syndrome are eligible for inclusion in this registry. Baseline characteristics and ECG variables reflecting depolarization and repolarization will be determined. The primary outcome is spontaneous ventricular tachycardia/ventricular fibrillation or sudden cardiac death. Secondary outcomes are inducible ventricular tachycardia/ventricular fibrillation and syncope.Results: As of November 15, 2019, 39 investigators from 32 cities in 18 countries had joined this registry. As of December 15, 2019, 1383 cases had been enrolled.Conclusions: The Brugada Electrocardiographic Indices Registry will evaluate the disease life course, risk factors, and prognosis in a large series of Brugada patients. It will therefore provide insights for improving risk stratification.

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