Clinical and Electrophysiologic Profile of Brugada Syndrome in Iranian Patients

2005 ◽  
Vol 13 (3) ◽  
pp. 241-246 ◽  
Author(s):  
Majid Haghjoo ◽  
Arash Arya ◽  
Zahra Emkanjoo ◽  
Mohammad Ali Sadr-Ameli
Keyword(s):  
Brugada Syndrome ◽  
Ventricular Arrhythmias ◽  
Symptomatic Patient ◽  
St Segment Elevation ◽  
Asymptomatic Patients ◽  
St Segment ◽  
Significant Difference ◽  
Pr Interval ◽  
Electrocardiographic Abnormalities

Clinical and electrophysiologic characteristics of 20 patients (15 males; mean age, 42 ± 9 years) with Brugada syndrome were studied. Electrocardiographic abnormalities (spontaneous in 6 and provoked in 14) were recognized in 5 symptomatic and 15 asymptomatic patients. Mean PR (188 ± 18 vs. 184 ± 24 ms) and QT (362 ± 34 vs. 382 ± 28 ms) intervals and ST-segment elevation (2.28 ± 0.42 vs. 2.70 ± 0.77 mm) were similar in both groups. The PR interval was slightly longer in males than females (191 ± 21 vs.168 ± 18 ms, p = 0.042), but ST-segment elevation (2.70 ± 0.78 vs. 2.24 ± 0.26 mm) was similar. The HV interval was longer in males than females (57 ± 4 vs. 50 ± 4 ms, p = 0.047). Ventricular arrhythmias were induced in 40% of asymptomatic patients. There was no significant difference in age, sex, PR interval, ST-segment elevation, or HV interval between inducible and non-inducible patients. A defibrillator was implanted in 8 patients. During 16 ± 2 months of follow-up, one symptomatic patient had appropriate device therapy. None of the asymptomatic and non-inducible patients experienced a cardiac event. Electrophysiologic data have no role in predicting inducibility in programmed stimulation.

scholarly journals Fever Unmasked Brugada Syndrome in Pediatric Patient: A Case Report

2020 ◽  
Vol 4 (2) ◽  
pp. 244-246
Author(s):  
Orhay Mirzapolos ◽  
Perry Marshall ◽  
April Brill
Keyword(s):  
Emergency Medicine ◽  
Case Report ◽  
Brugada Syndrome ◽  
Ventricular Arrhythmias ◽  
Cardiac Monitoring ◽  
St Segment Elevation ◽  
Cardioverter Defibrillator ◽  
St Segment ◽  
Viral Illness ◽  
Automatic Implantable Cardioverter Defibrillator

Introduction: Brugada syndrome is an arrhythmogenic disorder that is a known cause of sudden cardiac death. It is characterized by a pattern of ST segment elevation in the precordial leads on an electrocardiogram (EKG) due to a sodium channelopathy. Case Report: This case report highlights the case of a five-year-old female who presented to the emergency department with a febrile viral illness and had an EKG consistent with Brugada syndrome. Discussion: Fever is known to accentuate or unmask EKG changes associated with Brugada due to temperature sensitivity of the sodium channels. Conclusion: Febrile patients with Brugada are at particular risk for fatal ventricular arrhythmias and fevers should be treated aggressively by the emergency medicine provider. Emergency medicine providers should also consider admitting febrile patients with Brugada syndrome who do not have an automatic implantable cardioverter-defibrillator for cardiac monitoring.

scholarly journals Electrocardiographic Effects of Propofol versus Etomidate in Patients with Brugada Syndrome

2020 ◽  
Vol 132 (3) ◽  
pp. 440-451 ◽  
Author(s):  
Panagiotis Flamée ◽  
Varnavas Varnavas ◽  
Wendy Dewals ◽  
Hugo Carvalho ◽  
Wilfried Cools ◽  
...  
Keyword(s):  
Brugada Syndrome ◽  
St Segment Elevation ◽  
St Depression ◽  
St Segment ◽  
Qrs Prolongation ◽  
Significant Difference ◽  
Electrocardiographic Changes ◽  
St Elevation ◽  
The Right ◽  
Double Blinded

Abstract Background Brugada Syndrome is an inherited arrhythmogenic disease, characterized by the typical coved type ST-segment elevation in the right precordial leads from V1 through V3. The BrugadaDrugs.org Advisory Board recommends avoiding administration of propofol in patients with Brugada Syndrome. Since prospective studies are lacking, it was the purpose of this study to assess the electrocardiographic effects of propofol and etomidate on the ST- and QRS-segments. In this trial, it was hypothesized that administration of propofol or etomidate in bolus for induction of anesthesia, in patients with Brugada Syndrome, do not clinically affect the ST- and QRS-segments and do not induce arrhythmias. Methods In this prospective, double-blinded trial, 98 patients with established Brugada syndrome were randomized to receive propofol (2 to 3 mg/kg-1) or etomidate (0.2 to 0.3 mg/kg-1) for induction of anesthesia. The primary endpoints were the changes of the ST- and QRS-segment, and the occurrence of new arrhythmias upon induction of anesthesia. Results The analysis included 80 patients: 43 were administered propofol and 37 etomidate. None of the patients had a ST elevation greater than or equal to 0.2 mV, one in each group had a ST elevation of 0.15 mV. An ST depression up to −0.15mV was observed eleven times with propofol and five with etomidate. A QRS-prolongation of 25% upon induction was seen in one patient with propofol and three with etomidate. This trial failed to establish any evidence to suggest that changes in either group differed, with most percentiles being zero (median [25th, 75th], 0 [0, 0] vs. 0 [0, 0]). Finally, no new arrhythmias occurred perioperatively in both groups. Conclusions In this trial, there does not appear to be a significant difference in electrocardiographic changes in patients with Brugada syndrome when propofol versus etomidate were administered for induction of anesthesia. This study did not investigate electrocardiographic changes related to propofol used as an infusion for maintenance of anesthesia, so future studies would be warranted before conclusions about safety of propofol infusions in patients with Brugada syndrome can be determined. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Undiagnosed SARS-CoV-2 infection and outcome in patients with acute MI and no COVID-19 symptoms

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001617
Author(s):  
Zubair Akhtar ◽  
Fahmida Chowdhury ◽  
Mohammad Abdul Aleem ◽  
Probir Kumar Ghosh ◽  
Mahmudur Rahman ◽  
...  
Keyword(s):  
Disease Transmission ◽  
Hospital Admissions ◽  
Coronary Intervention ◽  
Nasopharyngeal Swab ◽  
St Segment Elevation ◽  
Kaplan Meier ◽  
Asymptomatic Patients ◽  
St Segment ◽  
Significant Difference ◽  
Disease Hospital

ObjectiveWe aimed to determine the prevalence and outcome of occult infection with SARS-CoV-2 and influenza in patients presenting with myocardial infarction (MI) without COVID-19 symptoms.MethodsWe conducted an observational study from 28 June to 11 August 2020, enrolling patients admitted to the National Institute of Cardiovascular Disease Hospital, Dhaka, Bangladesh, with ST-segment elevation MI (STEMI) or non-ST-segment elevation MI who did not meet WHO criteria for suspected COVID-19. Samples were collected by nasopharyngeal swab to test for SARS-CoV-2 and influenza virus by real-time reverse transcriptase PCR. We followed up patients at 3 months (13 weeks) postadmission to record adverse cardiovascular outcomes: all-cause death, new MI, heart failure and new percutaneous coronary intervention or stent thrombosis. Survival analysis was performed using the Kaplan-Meier method.ResultsWe enrolled 280 patients with MI, 79% male, mean age 54.5±11.8 years, 140 of whom were diagnosed with STEMI. We found 36 (13%) to be infected with SARS-CoV-2 and 1 with influenza. There was no significant difference between mortality rate observed among SARS-CoV-2 infected patients compared with non-infected (5 (14%) vs 26 (11%); p=0.564). A numerically shorter median time to a recurrent cardiovascular event was recorded among SARS-CoV-2 infected compared with non-infected patients (21 days, IQR: 8–46 vs 27 days, IQR: 7–44; p=0.378).ConclusionWe found a substantial rate of occult SARS-CoV-2 infection in the studied cohort, suggesting SARS-CoV-2 may precipitate MI. Asymptomatic patients with COVID-19 admitted with MI may contribute to disease transmission and warrants widespread testing of hospital admissions.

scholarly journals Comparative effect of streptokinase and alteplase on electrocardiogram and angiogram signs of myocardial reperfusion in ST segment elevation acute myocardial infarction

2008 ◽  
Vol 136 (9-10) ◽  
pp. 481-487 ◽  
Author(s):  
Miloje Tomasevic ◽  
Tomislav Kostic ◽  
Svetlana Apostolovic ◽  
Zoran Perisic ◽  
Danijela Djordjevic-Radojkovic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Reperfusion Arrhythmias ◽  
Residual Stenosis ◽  
St Segment Elevation ◽  
St Segment ◽  
Significant Difference ◽  
Coronary Events ◽  
Elevation Acute Myocardial Infarction

INTRODUCTION Modern pharmacological reperfusion in ST segment elevation acute myocardial infarction means the application of fibrin specific thrombolytics combined with modern antiplatelets therapy dual antiplateles therapy, acetylsalicylic acid and clopidogrel, and enoxaparin. The contribution of each agent has been widely examined in large clinical studies, but not sufficiently has been known about the effects of a combined approach, where the early angiography and percutaneous coronary intervention is added during hospitalization, if necessary. OBJECTIVE The aim of the paper is to compare the effects of streptokinase and alteplase, together with the standard modern adjuvant antiplatelets and anticoagulation therapy (aspirin, clopidogrel, enoxaparin) in patients with ST segment elevation acute myocardial infarction, on electrocardiographic and angiographic signs of the achieved myocardial reperfusion. METHOD The prospective study included 127 patients with the first ST segment elevation acute myocardial infarction who were treated with a fibrinolytic agent in the first 6 hours from the chest pain onset. The examined group included 40 patients on the alteplase reperfusion therapy, while the control 87 patients were on the streptokinase therapy. All the patients received the same adjuvant therapy and all were examined by coronary angiography on the 3rd to 10th day of hospitalization. Reperfusion effects were estimated on the basis of the following: ST segment resolution at 60, 90 and 120 minutes, the appearance of reperfusion arrhythmias at the electrocardiogram, percentage of residual stenosis at the 'culprit' artery, TIMI coronary flow at the 'culprit' artery and the appearance of new major adverse coronary events in the 6-month-follow-up period. RESULTS By analysing the resolution of the sum of ST segment elevation in infarction leading 60 minutes after the beginning of the medication application, we received a statistically significantly higher resolution of ST segment in the group of patients who received alteplase (p<0.05). 60 minutes after the application of thrombolytics, 64% of patients at streptokinase showed the absence of ST segment resolution (<30%), and 32% of patients at alteplase (p<0.0001). Reperfusion arrhythmias as the sign of successful myocardial reperfusion were present in 62.5% of patients at alteplase and in 57.4% of patients at streptokinase, but the difference is not statistically significant. There was no statistically significant difference in the degree of residual stenosis at the 'culprit' artery in the compared groups of patients. TIMI 3 flow was achieved in 75% of patients at alteplase and in 38% of patients at streptokinase (p<0.0001). There was no statistically significant difference in the frequency of major adverse coronary events in the 6-month-follow-up period after acute myocardial infarction. CONCLUSION Alteplase with modern adjuvant therapy of ST segment elevation acute myocardial infarction shows the earlier achievement of coronary perfusion as well as better coronary flow compared to streptokinase. There is no statistically significant difference in the frequency of reperfusion arrhythmias, degree of residual stenosis at the 'culprit' artery and the frequency of new coronary events in the 6-month-follow-up period after acute myocardial infarction.

scholarly journals The Significance of Dynamics of ST Segment Changes When Assessing the Effectiveness of Mechanical Reperfusion of the Myocardium in Hyperglycaemic Patients with Acute Myocardial Infarction with Persistent ST-Segment Elevation

2020 ◽  
pp. 1-6
Author(s):  
Marek Andres ◽  
Maciej Małecki ◽  
Ewa Konduracka ◽  
Jacek Legutko ◽  
Janusz Andres ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Glucose ◽  
Coronary Intervention ◽  
Glucose Metabolism Disorders ◽  
St Segment Elevation ◽  
Glucose Levels ◽  
St Segment ◽  
Significant Difference ◽  
St Elevation

Background: The coexistence of coronary heart disease and consequently, acute myocardial infarction with persistent ST-segment elevation (STEMI) and glucose metabolism disorders is well known. Still, glucose metabolism disorders in the STEMI population are not fully understood. We know that diabetes mellitus (DM) is a factor disabling the function of microcirculation, which in turn may affect the outcome of coronary intervention. The aim of this study was to evaluate the dynamics of ST-segment changes in ECG (electrocardiogram) in STEMI (ST-segment elevation myocardial infarction) patients with co-existing hyperglycaemia compared to those with normoglycaemia treated with a percutaneous coronary intervention (PCI), as well as to determine this parameter in the assessment of reperfusion effectiveness. Methods: The study included 92 patients with the diagnosis of STEMI enrolled in the PCI treatment and was divided into groups based on the glucose levels on admission (reactive hyperglycaemia): a group with higher glucose levels on admission (Glc ≥ 7.8 mmol/L, n = 46), a group with lower glucose levels on admission (Glc < 7.8 mmol/L, n = 46) and into groups based on the concentration of HbA1c: a group with a lower HbA1c level (<6.5% (48 mmol/mol), n=71) and a group with a higher level (≥6.5%, n=21). Results: On admission, there were no significant differences in terms of clinical characteristics between the groups of patients with normoglycemia and reactive hyperglycaemia. After PCI, the patients with normoglycemia had significantly higher (p = 0.021) dynamics of changes in the resolution of ST-segment elevation in ECG expressed in an indicator of sum STR (resolution of ST-elevation). A degree of resolution of ST elevation in ECG was significantly (p = 0.021) dependent on the level of blood glucose – higher the blood glucose level, weaker the resolution. The patients with glucose levels ≥7.8 mmol/L had significantly higher levels of CK and CK-MB during the first 48 hours of hospitalization. There was a statistically significant difference in the mean length of hospitalization between individuals from the group with lower and higher blood glucose levels on admission (p = 0.028). A 4-month follow-up revealed no significant difference in the incidence of major adverse cardiovascular events (MACE) in the study groups (p = 0.063). A 4-year follow-up of patients with higher levels of blood glucose on admission showed a higher incidence of MACE (p = 0.01). The patients with HbA1c ≥ 6.5% were older (p = 0.004), had a greater BMI > 30kg/m2 (p=0.019) and the lower ejection fraction of the left ventricle (p = 0.003) compared to those with the HbA1c levels <6.5%. The incidence of MACE in 4-month and 4-year follow-up was comparable in the study population.

scholarly journals Brugada pattern: a comprehensive review on the demographic and clinical spectrum

2019 ◽  
Vol 12 (7) ◽  
pp. e229829 ◽  
Author(s):  
Hassan Abbas ◽  
Sohaib Roomi ◽  
Waqas Ullah ◽  
Asrar Ahmad ◽  
Ganesh Gajanan
Keyword(s):  
Brugada Syndrome ◽  
Ventricular Arrhythmias ◽  
Ecg Changes ◽  
Unique Case ◽  
St Segment Elevation ◽  
T Wave ◽  
Comprehensive Literature Review ◽  
St Segment ◽  
Syndrome Pattern ◽  
Brugada Pattern

A prominent coved or saddle-shaped ST-segment elevation followed by T wave changes in V1-V3 and in the absence of other identifiable cause is termed as Brugada pattern. This pattern in the presence of documented ventricular arrhythmias or its symptoms (syncope, seizure) or significant family for sudden cardiac death or abovementioned ECG changes is called Brugada syndrome. Here we present a comprehensive literature review on the precipitation factors of Brugada syndrome/pattern by various stimuli, its presentation, associations, management and outcomes. We are also presenting a unique case of Brugada pattern where the patient’s Brugada pattern was unmasked at an extreme old age by infection.

Rhabdomyoma of the interventricular septum presenting as a Brugada phenocopy

2011 ◽  
Vol 21 (5) ◽  
pp. 591-594 ◽  
Author(s):  
Timothy Nguyen ◽  
John Smythe ◽  
Adrian Baranchuk
Keyword(s):  
Sudden Death ◽  
Brugada Syndrome ◽  
Ventricular Arrhythmias ◽  
Interventricular Septum ◽  
St Segment Elevation ◽  
St Segment ◽  
The Right

AbstractBrugada syndrome is a channelopathy characterised electrocardiographically by distinctive coved ST-segment elevation in the right precordial leads and is associated with a predisposition for sudden death secondary to ventricular arrhythmias in otherwise healthy patients. Previously known as Brugada-like patterns, Brugada phenocopies include agents and conditions that mimic true Brugada syndrome, presenting with an acquired Brugada Type-1 ECG pattern. We describe the first reported case of a 17-month-old female with an asymptomatic rhabdomyoma of the interventricular septum that presented as a Brugada phenocopy.

scholarly journals Salivary Alpha-amylase Activity Level in ST-segment Elevation Myocardial Infarction Patients

2019 ◽  
pp. 1-7
Author(s):  
Behrang Rezvani Kakhki ◽  
Mohsen Salarirad ◽  
Seyed Ali Akbar Shamsian ◽  
Javad Ramezani ◽  
Elnaz Vafadar Moradi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ventricular Arrhythmias ◽  
Activity Level ◽  
Alpha Amylase ◽  
Salivary Amylase ◽  
Salivary Alpha Amylase ◽  
St Segment Elevation ◽  
St Segment ◽  
Significant Difference ◽  
Malignant Ventricular Arrhythmia

Background and Objective: Sudden death is the main cause of mortality and disability in patients with coronary artery disease or myocardial infarction. The aim of this study was to evaluate the activity level of salivary alpha-amylase to predict malignant ventricular arrhythmias in ST-segment elevation myocardial infarction (STEMI) patients. Materials and Methods: In this analytical cross-sectional study, 42 patients with STEMI who referred to Imam Reza Hospital participated. First, salivary amylase was taken from all STEMI patients and then these patients were divided into two groups of patients with malignant ventricular arrhythmia or without malignant ventricular arrhythmia during 72 hours. Results: A total of 42 patients were included in the study out of which 30 (71.4%) were females and 12 (28.6%) males. The average salivary amylase in patients was 118/41 ± 96/87. There was no significant difference in the frequency of diabetes, blood pressure, blood lipids, ischemic heart disease, and involvement severity in both groups with arrhythmia and lack of arrhythmias (P> 0.05). Also there was no significant difference in systolic and diastolic blood pressure, respiratory rate, heart rate, oxygen saturation, blood glucose, temperature and severity of infarction (P> 0.05). However, the two groups were different in terms of salivary amylase levels. Salivary amylase levels were significantly higher in arrhythmic group than in the non-arrhythmic group (P< 0.001). Conclusions: Our result shows that there is a difference in the concentrations of salivary Alpha-amylase activity level in with and without ventricular arrhythmias groups.

Abstract 20180: Erroneous Diagnosis of Brugada Syndrome: Advanced Multi-Modality Coronary Evaluation to Establish an Ischemic Etiology for Recurrent Ventricular Arrhythmia

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Erin E Flatley ◽  
Andrew D Beaser ◽  
Husam H Balkhy ◽  
Sandeep Nathan ◽  
Joshua D Moss
Keyword(s):  
Chest Pain ◽  
Coronary Angiography ◽  
Brugada Syndrome ◽  
Ventricular Arrhythmias ◽  
Fractional Flow ◽  
Case Presentation ◽  
St Segment Elevation ◽  
Flow Reserve ◽  
St Segment ◽  
Erroneous Diagnosis

Introduction: Rapid diagnosis of ST-segment elevation (STE) myocardial infarction is mandatory for optimal treatment, but standard coronary angiography may occasionally result in misdiagnosis. Case presentation: A 54-year-old man was referred for second opinion on treatment of recurrent ventricular tachycardia (VT) and chest pain. Three years prior, he suffered a cardiac arrest requiring AED shock. Initial EKG showed 5-10 mm STE in leads V2-V6. Emergent coronary angiography at another facility reportedly showed non-obstructive disease, and STE resolved spontaneously. Procainamide challenge during a subsequent electrophysiology study elicited changes diagnosed as Brugada syndrome, and an ICD was implanted. Over the next several years, he had frequent episodes of VT, often associated with chest pain and terminated with anti-tachycardia pacing. Multiple antiarrhythmic drugs were ineffective, and VT ablation was recommended. Based on the history and original EKG, we proceeded with multi-modality coronary evaluation and provocative testing for coronary vasospasm. An indistinct proximal LAD lesion was further evaluated with fractional flow reserve (FFR) testing, showing a baseline FFR of 0.90 that decreased to 0.67 after administration of intracoronary adenosine. Optical coherence tomography (OCT) revealed 90% eccentric ostial LAD stenosis (see Figure). Given the location and severity of the lesion, he underwent successful robotic totally endoscopic beating heart LIMA-LAD bypass grafting. Post-operatively, both chest pain and episodes of VT resolved. Conclusions: The differential diagnosis of transient STE includes several non-coronary etiologies. However, in the setting of dramatic STE across the precordium and recurrent ventricular arrhythmias, a comprehensive, multi-modality coronary evaluation should be employed to identify lesions that may be otherwise equivocal via angiography or sites of significant vasospasm.

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