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Mode of onset of ventricular fibrillation in patients with early repolarization pattern vs. Brugada syndrome

  • 0Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 138-736 Poongnap-dong 388-1, Songpa-gu, Seoul, Republic of Korea. gbnam@amc.seoul.kr
European Heart Journal +

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November 3, 2009

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November 3, 2009

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Summary

This summary is machine-generated.

Early repolarization (ER) patterns can indicate a risk for ventricular fibrillation (VF). Transient J wave augmentation predicts VF episodes, often initiated by short-long-short sequences and shorter coupling intervals in ER patients compared to Brugada syndrome patients.

Area Of Science

  • Cardiology
  • Electrophysiology
  • Medical Diagnostics

Background

  • Early repolarization (ER) is an electrocardiogram (ECG) pattern sometimes associated with cardiac events.
  • The arrhythmogenic potential of ER, particularly in predicting multiple ventricular fibrillation (VF) episodes, requires further elucidation.
  • Distinguishing VF triggers in ER from those in Brugada syndrome (BrS) is clinically important.

Purpose Of The Study

  • To identify specific ECG features predicting multiple VF episodes in patients with ER.
  • To compare the mechanisms of VF initiation in ER with those in BrS.
  • To assess the prognostic significance of transient J wave augmentation in ER.

Main Methods

  • Analysis of premature ventricular contractions (PVCs) initiating VF episodes in patients with ER and BrS.
  • Comparison of VF onset patterns and coupling intervals between ER and BrS groups.
  • Clinical data review including syncope, sudden cardiac death, and implantable cardioverter-defibrillator shocks.

Main Results

  • Among 11 ER patients, 5 experienced electrical storm (ES), characterized by recurrent VF episodes.
  • ES in ER patients was preceded by transient, dramatic J wave accentuation.
  • VF episodes in ER were more frequently initiated by short-long-short (SLS) PVC sequences (72.4%) with shorter coupling intervals compared to BrS patients (15.1%).

Conclusions

  • The ER pattern is not always benign and can be associated with a high risk of VF.
  • Transient J wave augmentation may signal a proarrhythmic substrate in ER patients.
  • VF initiation in ER is commonly linked to SLS sequences and shorter coupling intervals than in BrS.

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