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Coexistence of atrioventricular accessory pathways and drug-induced type 1 Brugada pattern

Can Hasdemir1, Jimmy Jyh-Ming Juang1, Sedat Kose2

  • 1Department of Cardiology, Ege University School of Medicine, Izmir, Turkey.

Pacing and Clinical Electrophysiology : PACE
|June 29, 2018
PubMed

Insights

Drug-induced type 1 Brugada electrocardiogram (ECG) pattern (DI-Type1-BrP) is common in patients with atrioventricular accessory pathways (AV-APs). Specific ECG findings during preexcitation and tachycardia can indicate underlying DI-Type1-BrP and risk for arrhythmias.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Genetics

Background:

  • Atrial arrhythmias, including atrioventricular nodal reentrant tachycardia, can co-occur with drug-induced type 1 Brugada electrocardiogram (ECG) pattern (DI-Type1-BrP).
  • Patients with atrioventricular accessory pathways (AV-APs) may present with coexisting DI-Type1-BrP.

Purpose of the Study:

  • To determine the prevalence of DI-Type1-BrP in patients with AV-APs.
  • To investigate the clinical, electrocardiographic, electrophysiologic, and genetic characteristics of patients with AV-APs and DI-Type1-BrP.

Main Methods:

  • 124 patients with AV-APs and 84 controls underwent an ajmaline challenge test to detect DI-Type1-BrP.
  • Genetic screening was performed in 55 patients (19 with and 36 without DI-Type1-BrP).

Main Results:

  • DI-Type1-BrP was unmasked more frequently in patients with AV-APs (16.1%) compared to controls (4.8%).
  • Patients with DI-Type1-BrP exhibited distinct ECG patterns during preexcitation and orthodromic atrioventricular reentrant tachycardia (AVRT), including QRS abnormalities in V2.
  • A higher prevalence of mutations in Brugada-susceptibility genes was observed in patients with DI-Type1-BrP (36.8%) versus those without (8.3%).

Conclusions:

  • DI-Type1-BrP is prevalent in patients with AV-APs.
  • Specific 12-lead ECG characteristics during preexcitation and AVRT can identify patients with underlying DI-Type1-BrP.
  • These findings suggest an increased risk for malignant arrhythmias in patients with AV-APs and DI-Type1-BrP.
Abstract

Keywords:
Brugada syndromeWolff-Parkinson-White syndromeatrioventricular reentrant tachycardiageneticspreexcitation

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