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...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Akira Ueoka, Hiroshi Morita, Atsuyuki Watanabe, Yoshimasa Morimoto, Satoshi Kawada, Motomi Tachibana, Masakazu Miyamoto, Koji Nakagawa, Nobuhiro Nishii, Hiroshi Ito
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2018
Materias:	Brugada syndrome risk stratification sodium channel blocker ventricular fibrillation Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/83c4bf788c3143d09b941a1492773c90
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:83c4bf788c3143d09b941a1492773c90
record_format	dspace
spelling	oai:doaj.org-article:83c4bf788c3143d09b941a1492773c902021-11-12T17:01:48ZPrognostic Significance of the Sodium Channel Blocker Test in Patients With Brugada Syndrome10.1161/JAHA.118.0086172047-9980https://doaj.org/article/83c4bf788c3143d09b941a1492773c902018-05-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.118.008617https://doaj.org/toc/2047-9980BackgroundA 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.Akira UeokaHiroshi MoritaAtsuyuki WatanabeYoshimasa MorimotoSatoshi KawadaMotomi TachibanaMasakazu MiyamotoKoji NakagawaNobuhiro NishiiHiroshi ItoWileyarticleBrugada syndromerisk stratificationsodium channel blockerventricular fibrillationDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 7, Iss 10 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	Brugada syndrome risk stratification sodium channel blocker ventricular fibrillation Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Brugada syndrome risk stratification sodium channel blocker ventricular fibrillation Diseases of the circulatory (Cardiovascular) system RC666-701 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
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.
format	article
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
title	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_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_sort	prognostic significance of the sodium channel blocker test in patients with brugada syndrome
publisher	Wiley
publishDate	2018
url	https://doaj.org/article/83c4bf788c3143d09b941a1492773c90
work_keys_str_mv	AT akiraueoka prognosticsignificanceofthesodiumchannelblockertestinpatientswithbrugadasyndrome AT hiroshimorita prognosticsignificanceofthesodiumchannelblockertestinpatientswithbrugadasyndrome AT atsuyukiwatanabe prognosticsignificanceofthesodiumchannelblockertestinpatientswithbrugadasyndrome AT yoshimasamorimoto prognosticsignificanceofthesodiumchannelblockertestinpatientswithbrugadasyndrome AT satoshikawada prognosticsignificanceofthesodiumchannelblockertestinpatientswithbrugadasyndrome AT motomitachibana prognosticsignificanceofthesodiumchannelblockertestinpatientswithbrugadasyndrome AT masakazumiyamoto prognosticsignificanceofthesodiumchannelblockertestinpatientswithbrugadasyndrome AT kojinakagawa prognosticsignificanceofthesodiumchannelblockertestinpatientswithbrugadasyndrome AT nobuhironishii prognosticsignificanceofthesodiumchannelblockertestinpatientswithbrugadasyndrome AT hiroshiito prognosticsignificanceofthesodiumchannelblockertestinpatientswithbrugadasyndrome
_version_	1718430378809622528

Prognostic Significance of the Sodium Channel Blocker Test in Patients With Brugada Syndrome

Ejemplares similares