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Canadian Journal of Cardiology

Predictors of Ventricular Arrhythmias and Sudden Death in a Québec Cohort With Brugada Syndrome

Published:March 30, 2016DOI:https://doi.org/10.1016/j.cjca.2016.03.012

      Abstract

      Background

      Patients with Brugada syndrome (BrS) are at risk for ventricular arrhythmias (VAs) and sudden death. Identification of high-risk individuals beyond those with syncope or resuscitated sudden death remains a major challenge.

      Methods

      We assessed the value of clinical, electrophysiological, and electrocardiographic (ECG) features, including depolarization and repolarization metrics, in predicting arrhythmic events and sudden death in consecutive patients with BrS diagnosed between 2002 and 2013 in Quebec, Canada. Qualifying electrocardiograms with the highest type 1 ST-segment elevations were reviewed and analyzed by 2 electrophysiologists who were blinded to clinical history. Survival analyses were adjusted for Firth bias correction and left truncation.

      Results

      A total of 105 patients, 79.8% of whom were men, were diagnosed with BrS at a mean age of 46.2 ± 13.3 years and were followed for 59.6 ± 16.4 months. Ten (9.5%) had a history of cardiac arrest, 37 (35.2%) had syncope, and 7 (6.7%) experienced 20 arrhythmic events during follow-up, all consisting of appropriate ICD therapy (7 antitachycardia pacing; 13 shocks). In multivariate Cox regression analyses, a spontaneous type 1 electrocardiographic (ECG) pattern (hazard ratio [HR], 10.80; 95% confidence interval [CI], 1.03-113.87; P = 0.0476), maximal T peak-end (Tp-e) duration ≥ 100 ms (HR, 29.73; 95% CI, 1.33-666.37; P = 0.0325), and QRS duration in lead V6 > 110 ms (HR, 15.27; 95% CI, 1.07-217.42; P = 0.0443) were independently associated with VAs or aborted sudden cardiac death.

      Conclusions

      In a multicentre cohort with BrS from Quebec, Canada, VAs and sudden death were independently associated with standard 12-lead ECG features, including a spontaneous type 1 pattern, depolarization (QRS in lead V6), and repolarization (maximal Tp-e duration) criteria.

      Résumé

      Introduction

      Les patients souffrant du syndrome de Brugada (SBr) sont exposés a un risque d’arythmies ventriculaires (AV) et de mort subite. L’identification des individus a risque en dehors de ceux avec histoire de syncope ou de mort subite demeure un challenge important.

      Méthodes

      Nous avons évalué la valeur des caractéristiques cliniques, électrophysiologiques et électrocardiographiques, incluant les mesures de dépolarisation et de repolarisation, pour prédire les événements arythmiques et la mort subite chez des patients consécutifs ayant reçu un diagnostic de SBr entre 2002 et 2013 au Québec, au Canada. Les électrocardiogrammes diagnostiques avec sus-décalages du segment ST de type 1 les plus élevés ont été passés en revue et analysés par 2 électrophysiologistes qui ne connaissaient pas les antécédents cliniques. Les analyses de survie ont été ajustées en fonction de la correction de biais de Firth et la troncature à gauche.

      Résultats

      Un total de 105 patients, dont 79,8 % étaient des hommes, ont reçu un diagnostic de SBr à un âge moyen de 46,2 ± 13,3 ans et ont été suivis durant 59,6 ± 16,4 mois. Dix (9,5 %) avaient des antécédents d’arrêt cardiaque, 37 (35,2 %) de syncopes et 7 (6,7 %) ont presente 20 événements arythmiques durant le suivi, tous consistant en un traitement approprié par DCI (7 stimulations antitachycardie; 13 chocs). Par analyses de régression de Cox, un type I spontanne sur l’ électrocardiographique (ECG) (rapport de risque [RR], 10,80; intervalle de confiance [IC] à 95 %, 1,03-113,87; P = 0,0476), la durée maximale entre le sommet (p pour peak) et la fin (e pour end) de l’onde T (Tp-e) ≥ 100 ms (RR, 29,73; IC à 95 %, 1,33-666,37; P = 0,0325) et la durée du QRS en dérivation V6 > 110 ms (RR, 15,27; IC à 95 %, 1,07-217,42; P = 0,0443) ont été indépendamment associés aux AV ou à la mort subite d’origine cardiaque avortée.

      Conclusions

      Dans une cohorte multicentrique souffrant du SBr du Québec, au Canada, les AV et la mort subite ont été indépendamment associées à des caractéristiques d’ECG standard 12 dérivations, comprenant un tracé spontané de type 1, des critères de dépolarisation (QRS en dérivation V6) et de repolarisation (durée maximale Tp-e).
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