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Augmented ST-Segment Elevation during Recovery from Exercise Predicts Cardiac Events in Patients with Brugada Syndrome
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- Makimoto Hisaki
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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- Nakagawa Eiichiro
- Department of Cardiology, Osaka City General Hospital
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- Takaki Hiroshi
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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- Yamada Yuko
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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- Okamura Hideo
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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- Noda Takashi
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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- Satomi Kazuhiro
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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- Suyama Kazuhiro
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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- Aihara Naohiko
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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- Kurita Takashi
- Division of Cardiology, Department of Internal Medicine, Kinki University School of Medicine
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- Kamakura Shiro
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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- Shimizu Wataru
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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Description
Objectives: The goal of this study was to evaluate the prevalence and the clinical significance of ST-segment elevation during recovery from exercise testing.<BR>Background: During recovery from exercise testing, ST-segment elevation is reported in some patients with Brugada syndrome (BrS).<BR>Methods: Treadmill exercise testing was conducted for 93 patients (91 men), 46±14 years of age, with BrS (22 documented ventricular fibrillation, 35 syncope alone, and 36 asymptomatic); and for 102 healthy control subjects (97 men), 46±17 years of age. Patients were routinely followed up. The clinical end point was defined as the occurrence of sudden cardiac death, ventricular fibrillation, or sustained ventricular tachyarrhythmia.<BR>Results: Augmentation of ST-segment elevation ?0.05 mV in V(1) to V(3) leads compared with baseline was observed at early recovery (1 to 4 min at recovery) in 34 BrS patients (37% [group 1]), but was not observed in the remaining 59 BrS patients (63% [group 2]) or in the 102 control subjects. During 76±38 months of follow-up, ventricular fibrillation occurred more frequently in group 1 (15 of 34, 44%) than in group 2 (10 of 59, 17%; p=0.004). Multivariate Cox regression analysis showed that in addition to previous episodes of ventricular fibrillation (p=0.005), augmentation of ST-segment elevation at early recovery was a significant and independent predictor for cardiac events (p=0.007), especially among patients with history of syncope alone (6 of 12 [50%] in group 1 vs. 3 of 23 [13%] in group 2) and among asymptomatic patients (3 of 15 [20%] in group 1 vs. 0 of 21 [0%] in group 2).<BR>Conclusions: Augmentation of ST-segment elevation during recovery from exercise testing was specific in patients with BrS, and can be a predictor of poor prognosis, especially for patients with syncope alone and for asymptomatic patients.
Journal
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- Journal of Arrhythmia
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Journal of Arrhythmia 27 (Supplement), JAAC_3-, 2011
Japanese Heart Rhythm Society