PDF(Pubmed)
Abstract：
Brugada syndrome poses significant challenges in terms of risk stratification and management, particularly for asymptomatic patients who comprise the majority of individuals exhibiting Brugada ECG pattern (BrECG). The aim of this study was to evaluate the long-term prognosis of a large cohort of asymptomatic patients with BrECG.
Asymptomatic patients with BrECG (1149) were consecutively collected from 2 Italian centers and followed-up at least annually for 2 to 22 years. For the 539 asymptomatic patients (men, 433 [80%]; mean age, 46±13 years) with spontaneous type 1 documented on baseline ECG (87%) or 12-lead 24-hour Holter monitoring (13%), an electrophysiologic study (EPS) was proposed; for the 610 patients with drug-induced-only type 1 (men, 420 [69%]; mean age, 44±14 years), multiple ECGs and 12-lead Holter were advised in order to detect the occurrence of a spontaneous type-1 BrECG. Arrhythmic events were defined as sudden death or documented ventricular fibrillation or tachycardia.
Median follow-up was 6 (4-9) years. Seventeen (1.5%) arrhythmic events occurred in the overall asymptomatic population (corresponding to an event-rate of 0.2% per year), including 16 of 539 (0.4% per year) in patients with spontaneous type-1 BrECG and 1 of 610 in those with drug-induced type-1 BrECG (0.03% per year; P<0.001). EPS was performed in 339 (63%) patients with spontaneous type-1 BrECG. Patients with spontaneous type-1 BrECG and positive EPS had significantly higher event rates than patients with negative EPS (7 of 103 [0.7% per year] versus 4 of 236 [0.2% per year]; P=0.025). Among 200 patients who declined EPS, 5 events (0.4% per year) occurred. There was 1 device-related death.
The entire population of asymptomatic patients with BrECG exhibits a relatively low event rate per year, which is important in view of the long life expectancy of these young patients. The presence of spontaneous type-1 BrECG associated with positive EPS identifies a subgroup at higher risk. Asymptomatic patients with drug-induced-only BrECG have a minimal arrhythmic risk, but ongoing follow-up with 12-lead Holter monitoring is recommended to detect the appearance of spontaneous type-1 BrECG pattern.
Asymptomatic patients with BrECG (1149) were consecutively collected from 2 Italian centers and followed-up at least annually for 2 to 22 years. For the 539 asymptomatic patients (men, 433 [80%]; mean age, 46±13 years) with spontaneous type 1 documented on baseline ECG (87%) or 12-lead 24-hour Holter monitoring (13%), an electrophysiologic study (EPS) was proposed; for the 610 patients with drug-induced-only type 1 (men, 420 [69%]; mean age, 44±14 years), multiple ECGs and 12-lead Holter were advised in order to detect the occurrence of a spontaneous type-1 BrECG. Arrhythmic events were defined as sudden death or documented ventricular fibrillation or tachycardia.
Median follow-up was 6 (4-9) years. Seventeen (1.5%) arrhythmic events occurred in the overall asymptomatic population (corresponding to an event-rate of 0.2% per year), including 16 of 539 (0.4% per year) in patients with spontaneous type-1 BrECG and 1 of 610 in those with drug-induced type-1 BrECG (0.03% per year; P<0.001). EPS was performed in 339 (63%) patients with spontaneous type-1 BrECG. Patients with spontaneous type-1 BrECG and positive EPS had significantly higher event rates than patients with negative EPS (7 of 103 [0.7% per year] versus 4 of 236 [0.2% per year]; P=0.025). Among 200 patients who declined EPS, 5 events (0.4% per year) occurred. There was 1 device-related death.
The entire population of asymptomatic patients with BrECG exhibits a relatively low event rate per year, which is important in view of the long life expectancy of these young patients. The presence of spontaneous type-1 BrECG associated with positive EPS identifies a subgroup at higher risk. Asymptomatic patients with drug-induced-only BrECG have a minimal arrhythmic risk, but ongoing follow-up with 12-lead Holter monitoring is recommended to detect the appearance of spontaneous type-1 BrECG pattern.
摘要：
背景：Brugada综合征在风险分层和管理方面提出了重大挑战，特别是对于无症状患者，这些患者占显示Brugada模式ECG（BrECG）的大多数。这项研究的目的是评估大量无症状的BrECG患者的长期预后。
方法：从2个意大利中心连续收集有症状的BrECG患者（1149），每年至少随访2至22年。对于539名无症状患者(男性，433[80%]；平均年龄，46±13岁），在基线心电图（87％）或12导联24小时动态心电图监测（13％）上记录了自发性1型，提出了一项电生理研究（EPS）；对于610例仅药物诱导的1型患者（男性，420[69%]；平均年龄，44±14年），我们建议使用多个ECG和12导联Holter,以检测自发性1型BrECG模式的发生.心律失常事件定义为猝死或记录的室颤或心动过速。
结果：中位随访时间为6（4-9）年。在总体无症状人群中发生了17次（1.5％）心律失常事件（相当于每年0.2％的事件发生率）。包括自发性1型BrECG患者中的539例（每年0.4％）和药物诱导的1型BrECG患者中的1例（每年0.03％；P<0.001）。339例（63％）自发性1型BrECG患者进行了EPS。自发性1型BrECG和EPS阳性患者的事件发生率明显高于EPS阴性患者（103例中的7例[每年0.7％]与236例中的4例[每年0.2％]；P=0.025）。在200名拒绝EPS的患者中，发生5起事件（每年0.4%）。有1人与设备有关的死亡。
结论：所有无症状的BrECG患者每年的事件发生率相对较低，考虑到这些年轻患者的预期寿命很长，这一点很重要。与EPS阳性相关的自发性1型BrECG的存在确定了高风险的亚组。无症状的仅药物诱导的BrECG患者具有最小的心律失常风险，但建议持续随访12导联Holter监测以检测自发性1型BrECG模式的出现。
方法：从2个意大利中心连续收集有症状的BrECG患者（1149），每年至少随访2至22年。对于539名无症状患者(男性，433[80%]；平均年龄，46±13岁），在基线心电图（87％）或12导联24小时动态心电图监测（13％）上记录了自发性1型，提出了一项电生理研究（EPS）；对于610例仅药物诱导的1型患者（男性，420[69%]；平均年龄，44±14年），我们建议使用多个ECG和12导联Holter,以检测自发性1型BrECG模式的发生.心律失常事件定义为猝死或记录的室颤或心动过速。
结果：中位随访时间为6（4-9）年。在总体无症状人群中发生了17次（1.5％）心律失常事件（相当于每年0.2％的事件发生率）。包括自发性1型BrECG患者中的539例（每年0.4％）和药物诱导的1型BrECG患者中的1例（每年0.03％；P<0.001）。339例（63％）自发性1型BrECG患者进行了EPS。自发性1型BrECG和EPS阳性患者的事件发生率明显高于EPS阴性患者（103例中的7例[每年0.7％]与236例中的4例[每年0.2％]；P=0.025）。在200名拒绝EPS的患者中，发生5起事件（每年0.4%）。有1人与设备有关的死亡。
结论：所有无症状的BrECG患者每年的事件发生率相对较低，考虑到这些年轻患者的预期寿命很长，这一点很重要。与EPS阳性相关的自发性1型BrECG的存在确定了高风险的亚组。无症状的仅药物诱导的BrECG患者具有最小的心律失常风险，但建议持续随访12导联Holter监测以检测自发性1型BrECG模式的出现。
