The use of somtaosensory evoked potential (SSEP) and motor evoked potential (MEP) monitoring in a patient with Brugada syndrome (original) (raw)
Related papers
2002
Background: Brugada syndrome is characterized by ST segment elevation in the right precordial leads (V1-V3) and an episode of ventricular fibrillation (VF) in the absence of any structural heart diseases. In the present study, we examined the relationship between the electrocardiographic, electrophysiologic characteristics and the induction of VF by programmed ventricular stimulation (PVS) in patients with symptomatic Brugada syndrome. The implication of PVS-induced VF on the recurrence of cardiac events was also examined. Methods: Thirty-four patients with symptomatic Brugada syndrome were entered in this study. We divided the patients into 2 groups by the presence and the absence of VF induction; 22 patients with induced VF requiring direct cardioversion for termination (Induced VF group) and 12 patients without induced VF (Non induced VF group). Results: The QRS duration and the HV interval were longer, the incidence of right bundle branch block and late potentials detected by si...
Prognostic Value of Programmed Electrical Stimulation in Brugada Syndrome: 20 Years Experience
Circulation. Arrhythmia and electrophysiology, 2015
1 H He H art Rhythm m m Mana na nag geme e en n nt Centre, , , U U UZ Br Br Brusse e el---U VU UB B B; ; ; 2 2 2 De Depa ar rtm m ment of f f C C Car r rdiology gy gy, E Er Era asm m me Un Un Univ iver er rsi si sity ty ty H H Ho os ospi p t ta tal; ; ; 3 Ca ard rd rdia ia iac c c Su Su Surg g ger er ery y y D De Depa pa part tme me ment nt t, , UZ UZ UZ B B Bru ru russ s sel el l-V -V -VUB UB B, , , Br Br rus us usse s s ls ls s, , , B B Bel l lgi iu ium m C C Correspond d dence: by guest on June 2, 2016 http://circep.ahajournals.org/ Downloaded from Abstract Background -The prognostic value of electrophysiological investigations in individuals with Brugada syndrome remains controversial. Different groups have published contradictory data. Long-term follow up is needed to clarify this issue. Methods and Results -Patients presenting with spontaneous or drug-induced Brugada type I electrocardiogram (ECG) and in whom PES was performed at our institution were considered eligible for this study. A total of 403 consecutive patients (235 males, 58.2%; mean age: 43.2±16.2 years) were included. VA during PES were induced in 73 (18.1%) patients. After a mean follow-up time of 74.3±57.3 months, (median 57.3), 25 arrhythmic events occurred (16 in the inducible group and 9 in the non inducible). VA inducibility presented a hazard ratio for events of 8.3 (95% CI 3.6 -19.4), p<0.01. Conclusions -Programmed ventricular stimulation of the heart is a good predictor of outcome in individuals with Brugada syndrome. It might be of special value to guide further management when performed in asymptomatic individuals. The over-all accuracy of the test makes it a suitable screening tool to reassure non-inducible asymptomatic individuals Key words: Brugada syndrome, prognosis, arrhythmia ( ), p Conclusions -Programmed ventricular stimulation of the heart is a good predicto o or of of o o o out ut utco co com me m in ndividuals with Brugada syndrome. It might be of special value to guide further management wh h hen en en p perfo fo form rm rmed d d i i in n n asymptomatic individuals. Th h he e e o o over-all accura a acy c c of f f th th the test makes it a u u uit t ta able screeni ni ing n n too oo ol l l to o o r r re ea eass ss ssu ur ure e no no non---in in nduc ci cib b ble a asy y ymp pt ptom om omat at atic i i i i ind n ndi i ivid id idua ua u ls s by guest on June 2, 2016 http://circep.ahajournals.org/ Downloaded from
Prognostic Value of Electrophysiologic Investigations in Brugada Syndrome
Journal of Cardiovascular Electrophysiology, 2001
Brugada Syndrome. Introduction: The prognostic value of electrophysiologic investigations in individuals with Brugada syndrome is unclear. Previous studies failed to determine its value because of a limited number of patients or lack of events during follow-up. We present data on the prognostic value of electrophysiologic studies in the largest cohort ever collected of patients with Brugada syndrome. Methods and Results: Two hundred fty-two individuals with an ECG diagnostic of Brugada syndrome were studied electrophysiologically. The diagnosis was made because of a classic ECG with a coved-type ST segment elevation in precordial leads V 1 to V 3. Of the 252 individuals, 116 had previously developed spontaneous symptoms (syncope or aborted sudden cardiac death) and 136 were asymptomatic at the time of diagnosis. A sustained ventricular arrhythmia was induced in 130 patients (51%). Symptomatic patients were more frequently inducible (73%) than asymptomatic individuals (33%) (P 5 0.0001). Fifty-two individuals (21%) developed an arrhythmic event during a mean follow-up of 34 6 40 months. Inducibility was a powerful predictor of arrhythmic events during follow-up both in symptomatic and asymptomatic individuals. Overall accuracy of programmed ventricular stimulation to predict outcome was 67%. Overall accuracy in asymptomatic individuals was 70.5%, with a 99% negative predictive value. Overall accuracy in symptomatic patients was 62%, with only a 4.5% false-negative rate. No signi cant differences were found in the duration of the H-V interval during sinus rhythm between symptomatic or asymptomatic individuals. However, the H-V interval was signi cantly longer in the asymptomatic individuals who became symptomatic during follow-up compared with those who did not develop symptoms (59 6 8 msec vs 48 6 11 msec, respectively; P 5 0.04). Conclusion: Inducibility of sustained ventricular arrhythmias is a good predictor of outcome in Brugada syndrome. In asymptomatic individuals, a prolonged H-V interval during sinus rhythm is associated with a higher risk of developing arrhythmic events during follow-up. Symptomatic patients require protective treatment even when they are not inducible. Asymptomatic patients can be reassured if they are noninducible.
ICD Electrograms in Patients with Brugada Syndrome
Interpreting Cardiac Electrograms - From Skin to Endocardium, 2017
In patients with Brugada syndrome, implantable cardioverter-defibrillator (ICD) is the only demonstrated treatment that prevents sudden cardiac death. The progress in ICD technology improved the diagnosis and efficacy of implantable devices in the management and treatment of ventricular tachycardia (VT) and ventricular fibrillation (VF). Recording of electrical events just before and after a delivered or aborted ICD therapy permits a more accurate characterization of the rhythm but also provides information on the electrical events preceding the arrhythmia. This chapter aims to gain insight into the mechanism of initiation and termination of spontaneous VF by analyzing intracardiac electrograms (IEGM) in Brugada patients implanted with ICDs. It has two parts: (1) update on ICD electrograms in Brugada syndrome patients, where we review the medical literature on ICD electrograms and their use for detecting electrical manifestations of Brugada syndrome, and (2) examples of ICD electrograms, from our own database of patients affected by Brugada syndrome.
Caspian Journal of Internal Medicine, 2018
Background: Brugada syndrome (BrS) is an inherited channelopathy, which is associated with sudden cardiac death due to rapid polymorphic VT or VF. There is no definite consensus regarding the management of asymptomatic patients. Some experts advocate close follow-up; others propose the programmed stimulation for risk stratification. We aimed to evaluate the benefit of complete atrial and ventricular stimulation in patients with BrS and palpitation. Case Presentation: A 30-year-old man was admitted to our hospital because of a family history of sudden cardiac death (SCD) at age less than 45 years. He complained of selfterminated episodes of palpitation with no history of syncope. Baseline ECG showed incomplete right bundle branch block (RBBB) and saddle-back-like ST deviation in V1. Flecainide challenge test (FCT) revealed Brugada pattern. Complete EPS was done for evaluation of VT/VF inducibility and probable concomitant supraventricular arrhythmias. Programmed atrial stimulation showed inducible typical slow-fast AVNRT with AH jump 75 msec. Successful slow pathway ablation was done. There was no inducible ventricular arrhythmia. Conclusions: Patients with drug-induced BrS, positive family history of SCD and also episodes of palpitation, benefit from complete EPS. However, ICD implementation is not recommended in asymptomatic patients with drug-induced BrS and negative EPS for ventricular stimulation.
The American Journal of Cardiology, 2013
Prevalence and prognostic value of conduction disturbances in patients with the Brugada syndrome (BrS) remains poorly known. Electrocardiograms (ECGs) from 325 patients with BrS (47-13 years, 258 men) with spontaneous (n [ 143) or drug-induced (n [ 182) type 1 ECG were retrospectively reviewed. Two hundred twenty-six patients (70%) were asymptomatic, 73 patients (22%) presented with unexplained syncope, and 26 patients (8%) presented with sudden death or implantable cardioverter-defibrillator appropriated therapies at diagnosis or during a mean follow-up of 48-34 months. P-wave duration of ‡120 ms was present in 129 patients (40%), first degree atrioventricular block (AVB) in 113 (35%), right bundle branch block (BBB) in 90 (28%), and fascicular block in 52 (16%). Increased P-wave duration, first degree AVB, and right BBB were more often present in patients after drug challenge than in patients with spontaneous type 1 ST elevation. Left BBB was present in 3 patients. SCN5A mutation carriers had longer P-wave duration and longer PR and HV intervals. In multivariate analysis, first degree AVB was independently associated with sudden death or implantable cardioverter-defibrillator appropriated therapies (odds ratio 2.41, 95% confidence interval 1.01 to 5.73, p [ 0.046) together with the presence of syncope and spontaneous type 1 ST elevation. In conclusion, conduction disturbances are frequent and sometimes diffuse in patients with BrS. First degree AVB is independently linked to outcome and may be proposed to be used for individual risk stratification.
Programmed Electrical Stimulation in Brugada Syndrome: How Reproducible Are the Results?
Journal of Cardiovascular Electrophysiology, 2002
PES in Brugada Syndrome. Introduction: Inducibility of ventricular arrhythmias at programmed electrical stimulation (PES) ranges between 50% and 80% of patients with Brugada syndrome. However, the variety of PES protocols and the lack of data relative to a control group or to ventricular arrhythmia reproducibility contribute to a still unde ned interpretation of PES outcome in Brugada syndrome.
The Surgical Patient with Brugada Syndrome: A Four-Case Clinical Experience
Anesthesia & Analgesia, 2005
Brugada syndrome is characterized by a distinctive electrocardiographic pattern (right bundle branch block and ST segment elevation in precordial leads) and a high risk of cardiac arrest for malignant dysrhythmia. The genetic basis is a molecular defect of the cardiac sodium channel and the pattern of inheritance is autosomal dominant. Many factors during general anesthesia (medications, bradycardia, temperature changes) could precipitate malignant dysrhythmia in these patients. Because criteria to identify the surgical patient at high risk for developing malignant dysrhythmia are lacking, we can only speculate about the available studies on nonsurgical patients. We describe four patients during general anesthesia and propose intraoperative and postoperative monitoring (the first 36 h).