Document Detail

Electrophysiologic investigation in Brugada syndrome; yield of programmed ventricular stimulation at two ventricular sites with up to three premature beats.
MedLine Citation:
PMID:  12191751     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Numerous reports on the inducibility of ventricular tachyarrhythmias (VT) in patients with atypical right bundle branch block and right precordial ST-elevation (Brugada syndrome) are based on multicentre studies that have used different stimulation protocols. Therefore, we prospectively investigated the inducibility of VT in these patients using a uniform protocol. METHODS: In 41 consecutive patients (29 males) showing a pattern of right bundle branch block and ST-elevation, programmed ventricular stimulation was performed in the right ventricular apex with up to three premature stimuli at sinus rhythm and at four different paced cycle lengths (500, 430, 370, and 330 ms) until refractoriness was reached or reproducible induction of a sustained (>30s) VT occurred. If a VT was not reproducibly inducible, the same protocol was repeated in the right ventricular outflow tract. RESULTS: A history of life-threatening events defined as syncope (n=17) or aborted sudden cardiac death (n=13) was present in 30 patients (73%); 11 individuals were asymptomatic. Inducibility (68%) was similar between symptomatic (n=21, 70%) and asymptomatic patients (n=7, 64%). In 16 (39%) patients, VT were reproducibly inducible. If patients were only stimulated in the right ventricular apex, inducibility rate decreased to 39%. If only two premature beats at two sites were used it was as low as 32%. The mean coupling intervals of the second and third premature stimuli inducing sustained VT were short: 189+/-21 ms vs 186+/-22 ms, respectively. Forty-four percent of all patients (i.e. 64% of the inducible patients) had inducible VT only with coupling intervals shorter than 200 ms. CONCLUSIONS: The stimulation protocol markedly influences the extent of inducibility of VT in patients with right bundle branch block and ST-segment elevation. These findings question the significance of previous multicentre studies using different stimulation protocols and should have implications for further studies.
L Eckardt; P Kirchhof; E Schulze-Bahr; S Rolf; M Ribbing; P Loh; H-J Bruns; A Witte; P Milberg; M Borggrefe; G Breithardt; T Wichter; W Haverkamp
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  European heart journal     Volume:  23     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2002 Sep 
Date Detail:
Created Date:  2002-08-22     Completed Date:  2002-12-11     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  1394-401     Citation Subset:  IM    
Copyright Information:
Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.
Hospital of the Westfälische Wilhelms-University, Department of Cardiology and Angiology and Institute for Arteriosclerosis Research, Münster, Germany.
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MeSH Terms
Bundle-Branch Block / physiopathology*
Defibrillators, Implantable
Electrophysiologic Techniques, Cardiac
Middle Aged
Prospective Studies
Tachycardia, Ventricular / physiopathology*
Ventricular Fibrillation / physiopathology

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