Skip to main content
Erschienen in: Heart and Vessels 3/2017

01.08.2016 | Original Article

The utility of T-wave alternans during the morning in the summer for the risk stratification of patients with Brugada syndrome

verfasst von: Shogo Sakamoto, Masahiko Takagi, Jun Kakihara, Yusuke Hayashi, Atsushi Doi, Kenichi Sugioka, Minoru Yoshiyama

Erschienen in: Heart and Vessels | Ausgabe 3/2017

Einloggen, um Zugang zu erhalten

Abstract

The prognostic value of the seasonal variations of T-wave alternans (TWA) and heart rate variability (HRV), and the seasonal distribution of ventricular fibrillation (VF) in Brugada syndrome (Br-S) is unknown. We assessed the utility of seasonal variations in TWA and HRV for risk stratification in Br-S using a 24-h multichannel Holter electrocardiogram (24-M-ECG). We enrolled 81 patients with Br-S (grouped according to their history of VF, n = 12; syncope, n = 8; no symptoms, n = 61) who underwent 24-M-ECG in all four seasons. Precordial electrodes were attached to the third (3L-V2) and fourth (4L-V2, 4L-V5) intercostal spaces. We determined the maximum TWA (max-TWA) values and calculated HRV during night and morning time periods for all seasons. During a follow-up period of 5.8 ± 2.8 years, 11 patients experienced new VF episodes and there was a peak in new VF episodes in the summer. The VF group had the greatest 3L-V2 max-TWA value during morning time in the summer among the three groups and showed higher 3L-V2 max-TWA value than in the other seasons. The cutoff value for the 3L-V2 max-TWA during morning time in the summer was determined to be 42 µV using ROC analysis (82 % sensitivity, 74 % specificity; p = 0.0006). Multivariate analysis revealed that a 3L-V2 max-TWA value ≥42 µV during morning time in the summer and previous VF episodes were predictors of future VF episodes. The 3L-V2 max-TWA value during morning time in the summer may be a useful predictor of future VF episodes in Br-S.
Literatur
2.
Zurück zum Zitat Talib AK, Sato N, Myojo T, Sugiyama E, Nakagawa N, Sakamoto N, Tanabe Y, Fujino T, Takeuchi T, Akasaka K, Matsuhashi H, Saijo Y, Kawamura Y, Doi A, Hasebe N (2016) Insight into specific pro-arrhythmic triggers in Brugada and early repolarization syndromes: results of long-term follow-up. Heart Vessels. doi:10.1007/s00380-016-0828-8 PubMed Talib AK, Sato N, Myojo T, Sugiyama E, Nakagawa N, Sakamoto N, Tanabe Y, Fujino T, Takeuchi T, Akasaka K, Matsuhashi H, Saijo Y, Kawamura Y, Doi A, Hasebe N (2016) Insight into specific pro-arrhythmic triggers in Brugada and early repolarization syndromes: results of long-term follow-up. Heart Vessels. doi:10.​1007/​s00380-016-0828-8 PubMed
3.
Zurück zum Zitat Talib AK, Sato N, Kawabata N, Sugiyama E, Sakamoto N, Tanabe Y, Fujino T, Takeuchi T, Saijo Y, Akasaka K, Kawamura Y, Hasebe N (2014) Repolarization characteristics in early repolarization and Brugada syndromes: insight into an overlapping mechanism of lethal arrhythmias. J Cardiovasc Electrophysiol 25:1376–1384PubMed Talib AK, Sato N, Kawabata N, Sugiyama E, Sakamoto N, Tanabe Y, Fujino T, Takeuchi T, Saijo Y, Akasaka K, Kawamura Y, Hasebe N (2014) Repolarization characteristics in early repolarization and Brugada syndromes: insight into an overlapping mechanism of lethal arrhythmias. J Cardiovasc Electrophysiol 25:1376–1384PubMed
4.
Zurück zum Zitat Kim SH, Nam GB, Baek S, Choi HO, Kim KH, Choi KJ, Joung B, Pak HN, Lee MH, Kim SS, Park SJ, On YK, Kim JS, Oh IY, Choi EK, Oh S, Choi YS, Choi JI, Park SW, Kim YH, Lee MY, Lim HE, Lee YS, Cho Y, Kim J, Lee DI, Cho DK, Kim YH (2012) Circadian and seasonal variations of ventricular tachyarrhythmias in patients with early repolarization syndrome and Brugada syndrome: analysis of patients with implantable cardioverter defibrillator. J Cardiovasc Electrophysiol 23:757–763CrossRefPubMed Kim SH, Nam GB, Baek S, Choi HO, Kim KH, Choi KJ, Joung B, Pak HN, Lee MH, Kim SS, Park SJ, On YK, Kim JS, Oh IY, Choi EK, Oh S, Choi YS, Choi JI, Park SW, Kim YH, Lee MY, Lim HE, Lee YS, Cho Y, Kim J, Lee DI, Cho DK, Kim YH (2012) Circadian and seasonal variations of ventricular tachyarrhythmias in patients with early repolarization syndrome and Brugada syndrome: analysis of patients with implantable cardioverter defibrillator. J Cardiovasc Electrophysiol 23:757–763CrossRefPubMed
5.
Zurück zum Zitat Takigawa M, Noda T, Shimizu W, Miyamoto K, Okamura H, Satomi K, Suyama K, Aihara N, Kamakura S, Kurita T (2008) Seasonal and circadian distributions of ventricular fibrillation in patients with Brugada syndrome. Heart Rhythm 5:1523–1527CrossRefPubMed Takigawa M, Noda T, Shimizu W, Miyamoto K, Okamura H, Satomi K, Suyama K, Aihara N, Kamakura S, Kurita T (2008) Seasonal and circadian distributions of ventricular fibrillation in patients with Brugada syndrome. Heart Rhythm 5:1523–1527CrossRefPubMed
6.
Zurück zum Zitat Uchimura-Makita Y, Nakano Y, Tokuyama T, Fujiwara M, Watanabe Y, Sairaku A, Kawazoe H, Matsumura H, Oda N, Ikanaga H, Motoda C, Kajihara K, Oda N, Verrier RL, Kihara Y (2014) Time-domain T-wave alternans is strongly associated with a history of ventricular fibrillation in patients with Brugada syndrome. J Cardiovasc Electrophysiol 25:1021–1027CrossRefPubMed Uchimura-Makita Y, Nakano Y, Tokuyama T, Fujiwara M, Watanabe Y, Sairaku A, Kawazoe H, Matsumura H, Oda N, Ikanaga H, Motoda C, Kajihara K, Oda N, Verrier RL, Kihara Y (2014) Time-domain T-wave alternans is strongly associated with a history of ventricular fibrillation in patients with Brugada syndrome. J Cardiovasc Electrophysiol 25:1021–1027CrossRefPubMed
7.
Zurück zum Zitat Tobaldini E, Brugada J, Benito B, Molina I, Montserrat J, Kara T, Leinveber P, Porta A, Macedo PG, Montano N, Somers VK (2013) Cardiac autonomic control in Brugada syndrome patients during sleep: cardiac autonomic control in Brugada syndrome patients during sleep: the effects of sleep disordered breathing. Int J Cardiol 168:3267–3272CrossRefPubMed Tobaldini E, Brugada J, Benito B, Molina I, Montserrat J, Kara T, Leinveber P, Porta A, Macedo PG, Montano N, Somers VK (2013) Cardiac autonomic control in Brugada syndrome patients during sleep: cardiac autonomic control in Brugada syndrome patients during sleep: the effects of sleep disordered breathing. Int J Cardiol 168:3267–3272CrossRefPubMed
8.
Zurück zum Zitat Priori SG, Wilde AA, Horie M, Cho Y, Behr ER, Berul C, Blom N, Brugada J, Chiang CE, Huikuri H, Kannankeril P, Krahn A, Leenhardt A, Moss A, Schwartz PJ, Shimizu W, Tomaselli G, Tracy C, Ackerman M, Belhassen B, Estes NA 3rd, Fatkin D, Kalman J, Kaufman E, Kirchhof P, Schulze-Bahr E, Wolpert C, Vohra J, Refaat M, Etheridge SP, Campbell RM, Martin ET, Quek SC (2013) Executive summary: HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes. Europace 15:1389–1406CrossRefPubMed Priori SG, Wilde AA, Horie M, Cho Y, Behr ER, Berul C, Blom N, Brugada J, Chiang CE, Huikuri H, Kannankeril P, Krahn A, Leenhardt A, Moss A, Schwartz PJ, Shimizu W, Tomaselli G, Tracy C, Ackerman M, Belhassen B, Estes NA 3rd, Fatkin D, Kalman J, Kaufman E, Kirchhof P, Schulze-Bahr E, Wolpert C, Vohra J, Refaat M, Etheridge SP, Campbell RM, Martin ET, Quek SC (2013) Executive summary: HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes. Europace 15:1389–1406CrossRefPubMed
9.
Zurück zum Zitat JCS Joint Working Group (2012) Guidelines for risks and prevention of sudden cardiac death (JCS 2010): digest version. Circ J 76:489–507CrossRef JCS Joint Working Group (2012) Guidelines for risks and prevention of sudden cardiac death (JCS 2010): digest version. Circ J 76:489–507CrossRef
10.
Zurück zum Zitat Verrier RL, Klingenheben T, Malik M, El-Sherif N, Exner DV, Hohnloser SH, Ikeda T, Martinez JP, Narayan SM, Nieminen T, Rosenbaum DS (2011) Microvolt T-wave alternans physiological basis, methods of measurement, and clinical utility-consensus guideline by International Society for Holter and Noninvasive Electrocardiology. J Am Coll Cardiol 58:1309–1324CrossRefPubMedPubMedCentral Verrier RL, Klingenheben T, Malik M, El-Sherif N, Exner DV, Hohnloser SH, Ikeda T, Martinez JP, Narayan SM, Nieminen T, Rosenbaum DS (2011) Microvolt T-wave alternans physiological basis, methods of measurement, and clinical utility-consensus guideline by International Society for Holter and Noninvasive Electrocardiology. J Am Coll Cardiol 58:1309–1324CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Takasugi N, Nishigaki K, Kubota T, Tsuchiya K, Natsuyama K, Takasugi M, Nawa T, Ojio S, Aoyama T, Kawasaki M, Takemura G, Minatoguchi S (2009) Sleep apnoea induces cardiac electrical instability assessed by T-wave alternans in patients with congestive heart failure. Eur J Heart Fail 11:1063–1070CrossRefPubMed Takasugi N, Nishigaki K, Kubota T, Tsuchiya K, Natsuyama K, Takasugi M, Nawa T, Ojio S, Aoyama T, Kawasaki M, Takemura G, Minatoguchi S (2009) Sleep apnoea induces cardiac electrical instability assessed by T-wave alternans in patients with congestive heart failure. Eur J Heart Fail 11:1063–1070CrossRefPubMed
12.
Zurück zum Zitat Hermida JS, Leenhardt A, Cauchemez B, Denjoy I, Jarry G, Mizon F, Milliez P, Rey JL, Beaufils P, Coumel P (2003) Decreased nocturnal standard deviation of averaged NN intervals. An independent marker to identify patients at risk in the Brugada syndrome. Eur Heart J 24:2061–2069CrossRefPubMed Hermida JS, Leenhardt A, Cauchemez B, Denjoy I, Jarry G, Mizon F, Milliez P, Rey JL, Beaufils P, Coumel P (2003) Decreased nocturnal standard deviation of averaged NN intervals. An independent marker to identify patients at risk in the Brugada syndrome. Eur Heart J 24:2061–2069CrossRefPubMed
13.
Zurück zum Zitat Kirchhof P, Eckardt L, Rolf S, Esperer HD, Paul M, Wichter T, Klein HU, Breithardt G, Bocker D (2004) T wave alternans does not assess arrhythmic risk in patients with Brugada syndrome. Ann Noninvasive Electrocardiol 9:162–165CrossRefPubMed Kirchhof P, Eckardt L, Rolf S, Esperer HD, Paul M, Wichter T, Klein HU, Breithardt G, Bocker D (2004) T wave alternans does not assess arrhythmic risk in patients with Brugada syndrome. Ann Noninvasive Electrocardiol 9:162–165CrossRefPubMed
14.
Zurück zum Zitat Ikeda T, Takami M, Sugi K, Mizusawa Y, Sakurada H, Yoshino H (2005) Noninvasive risk stratification of subjects with a Brugada-type electrocardiogram and no history of cardiac arrest. Ann Noninvasive Electrocardiol 10:396–403CrossRefPubMed Ikeda T, Takami M, Sugi K, Mizusawa Y, Sakurada H, Yoshino H (2005) Noninvasive risk stratification of subjects with a Brugada-type electrocardiogram and no history of cardiac arrest. Ann Noninvasive Electrocardiol 10:396–403CrossRefPubMed
15.
Zurück zum Zitat Kawazoe H, Nakano Y, Ochi H, Takagi M, Hayashi Y, Uchimura Y, Tokuyama T, Watanabe Y, Matsumura H, Tomomori S, Sairaku A, Suenari K, Awazu A, Miwa Y, Soejima K, Chayama K, Kihara Y (2016) Risk stratification of ventricular fibrillation in brugada syndrome using noninvasive scoring methods. Heart Rhythm. doi:10.1016/j.hrthm.2016.07.009 Kawazoe H, Nakano Y, Ochi H, Takagi M, Hayashi Y, Uchimura Y, Tokuyama T, Watanabe Y, Matsumura H, Tomomori S, Sairaku A, Suenari K, Awazu A, Miwa Y, Soejima K, Chayama K, Kihara Y (2016) Risk stratification of ventricular fibrillation in brugada syndrome using noninvasive scoring methods. Heart Rhythm. doi:10.​1016/​j.​hrthm.​2016.​07.​009
16.
Zurück zum Zitat Sakamoto S, Takagi M, Tatsumi H, Doi A, Sugioka K, Hanatani A, Yoshiyama M (2016) Utility of T-wave alternans during night time as a predictor for ventricular fibrillation in patients with Brugada syndrome. Heart Vessels 31:947–956CrossRefPubMed Sakamoto S, Takagi M, Tatsumi H, Doi A, Sugioka K, Hanatani A, Yoshiyama M (2016) Utility of T-wave alternans during night time as a predictor for ventricular fibrillation in patients with Brugada syndrome. Heart Vessels 31:947–956CrossRefPubMed
17.
Zurück zum Zitat Morita H, Zipes DP, Morita ST, Wu J (2007) Differences in arrhythmogenicity between the canine right ventricular outflow tract and anteroinferior right ventricle in a model of Brugada syndrome. Heart Rhythm 4:66–74CrossRefPubMed Morita H, Zipes DP, Morita ST, Wu J (2007) Differences in arrhythmogenicity between the canine right ventricular outflow tract and anteroinferior right ventricle in a model of Brugada syndrome. Heart Rhythm 4:66–74CrossRefPubMed
18.
Zurück zum Zitat Yamasaki H, Tada H, Sekiguchi Y, Aonuma K (2015) Right coronary cusp as a new window of ablation for pilsicainide-induced ventricular premature contractions in a patient with Brugada syndrome. Heart Vessels. doi:10.1007/s00380-015-0760-3 Yamasaki H, Tada H, Sekiguchi Y, Aonuma K (2015) Right coronary cusp as a new window of ablation for pilsicainide-induced ventricular premature contractions in a patient with Brugada syndrome. Heart Vessels. doi:10.​1007/​s00380-015-0760-3
19.
Zurück zum Zitat Shimeno K, Takagi M, Maeda K, Tatsumi H, Doi A, Nakagawa E, Yoshiyama M (2009) Usefulness of multichannel Holter ECG recording in the third intercostal space for detecting type 1 Brugada ECG: comparison with repeated 12-lead ECGs. J Cardiovasc Electrophysiol 20:1026–1031CrossRefPubMed Shimeno K, Takagi M, Maeda K, Tatsumi H, Doi A, Nakagawa E, Yoshiyama M (2009) Usefulness of multichannel Holter ECG recording in the third intercostal space for detecting type 1 Brugada ECG: comparison with repeated 12-lead ECGs. J Cardiovasc Electrophysiol 20:1026–1031CrossRefPubMed
20.
Zurück zum Zitat Delise P, Allocca G, Marras E, Giustetto C, Gaita F, Sciarra L, Calo L, Proclemer A, Marziali M, Rebellato L, Berton G, Coro L, Sitta N (2011) Risk stratification in individuals with the Brugada type 1 ECG pattern without previous cardiac arrest: usefulness of a combined clinical and electrophysiologic approach. Eur Heart J 32:169–176CrossRefPubMed Delise P, Allocca G, Marras E, Giustetto C, Gaita F, Sciarra L, Calo L, Proclemer A, Marziali M, Rebellato L, Berton G, Coro L, Sitta N (2011) Risk stratification in individuals with the Brugada type 1 ECG pattern without previous cardiac arrest: usefulness of a combined clinical and electrophysiologic approach. Eur Heart J 32:169–176CrossRefPubMed
21.
Zurück zum Zitat Nakano Y, Shimizu W, Ogi H, Suenari K, Oda N, Makita Y, Kajihara K, Hirai Y, Sairaku A, Tokuyama T, Tonouchi Y, Ueda S, Sueda T, Chayama K, Kihara Y (2010) A spontaneous type 1 electrocardiogram pattern in lead V2 is an independent predictor of ventricular fibrillation in Brugada syndrome. Europace 12:410–416CrossRefPubMed Nakano Y, Shimizu W, Ogi H, Suenari K, Oda N, Makita Y, Kajihara K, Hirai Y, Sairaku A, Tokuyama T, Tonouchi Y, Ueda S, Sueda T, Chayama K, Kihara Y (2010) A spontaneous type 1 electrocardiogram pattern in lead V2 is an independent predictor of ventricular fibrillation in Brugada syndrome. Europace 12:410–416CrossRefPubMed
22.
Zurück zum Zitat Antzelevitch C, Brugada P, Brugada J, Brugada R, Shimizu W, Gussak I, Perez Riera AR (2002) Brugada syndrome: a decade of progress. Circ Res 91:1114–1118CrossRefPubMed Antzelevitch C, Brugada P, Brugada J, Brugada R, Shimizu W, Gussak I, Perez Riera AR (2002) Brugada syndrome: a decade of progress. Circ Res 91:1114–1118CrossRefPubMed
23.
Zurück zum Zitat Kruse HJ, Wieczorek I, Hecker H, Creutzig A, Schellong SM (2002) Seasonal variation of endothelin-1, angiotensin II, and plasma catecholamines and their relation to outside temperature. J Lab Clin Med 140:236–241CrossRefPubMed Kruse HJ, Wieczorek I, Hecker H, Creutzig A, Schellong SM (2002) Seasonal variation of endothelin-1, angiotensin II, and plasma catecholamines and their relation to outside temperature. J Lab Clin Med 140:236–241CrossRefPubMed
24.
Zurück zum Zitat Matsuo K, Kurita T, Inagaki M, Kakishita M, Aihara N, Shimizu W, Taguchi A, Suyama K, Kamakura S, Shimomura K (1999) The circadian pattern of the development of ventricular fibrillation in patients with Brugada syndrome. Eur Heart J 20:465–470CrossRefPubMed Matsuo K, Kurita T, Inagaki M, Kakishita M, Aihara N, Shimizu W, Taguchi A, Suyama K, Kamakura S, Shimomura K (1999) The circadian pattern of the development of ventricular fibrillation in patients with Brugada syndrome. Eur Heart J 20:465–470CrossRefPubMed
25.
Zurück zum Zitat Nishida K, Fujiki A, Mizumaki K, Sakabe M, Sugao M, Tsuneda T, Inoue H (2004) Canine model of Brugada syndrome using regional epicardial cooling of the right ventricular outflow tract. J Cardiovasc Electrophysiol 15:936–941CrossRefPubMed Nishida K, Fujiki A, Mizumaki K, Sakabe M, Sugao M, Tsuneda T, Inoue H (2004) Canine model of Brugada syndrome using regional epicardial cooling of the right ventricular outflow tract. J Cardiovasc Electrophysiol 15:936–941CrossRefPubMed
26.
Zurück zum Zitat Tsuji H, Larson MG, Venditti FJ Jr, Manders ES, Evans JC, Feldman CL, Levy D (1996) Impact of reduced heart rate variability on risk for cardiac events. The Framingham Heart Study. Circulation 94:2850–2855CrossRefPubMed Tsuji H, Larson MG, Venditti FJ Jr, Manders ES, Evans JC, Feldman CL, Levy D (1996) Impact of reduced heart rate variability on risk for cardiac events. The Framingham Heart Study. Circulation 94:2850–2855CrossRefPubMed
27.
Zurück zum Zitat Pierre B, Babuty D, Poret P, Giraudeau C, Marie O, Cosnay P, Fauchier L (2007) Abnormal nocturnal heart rate variability and QT dynamics in patients with Brugada syndrome. Pacing Clin Electrophysiol 30 Suppl 1:S188–S191PubMed Pierre B, Babuty D, Poret P, Giraudeau C, Marie O, Cosnay P, Fauchier L (2007) Abnormal nocturnal heart rate variability and QT dynamics in patients with Brugada syndrome. Pacing Clin Electrophysiol 30 Suppl 1:S188–S191PubMed
28.
Zurück zum Zitat Ikeda T, Abe A, Yusu S, Nakamura K, Ishiguro H, Mera H, Yotsukura M, Yoshino H (2006) The full stomach test as a novel diagnostic technique for identifying patients at risk of Brugada syndrome. J Cardiovasc Electrophysiol 17:602–607CrossRefPubMed Ikeda T, Abe A, Yusu S, Nakamura K, Ishiguro H, Mera H, Yotsukura M, Yoshino H (2006) The full stomach test as a novel diagnostic technique for identifying patients at risk of Brugada syndrome. J Cardiovasc Electrophysiol 17:602–607CrossRefPubMed
Metadaten
Titel
The utility of T-wave alternans during the morning in the summer for the risk stratification of patients with Brugada syndrome
verfasst von
Shogo Sakamoto
Masahiko Takagi
Jun Kakihara
Yusuke Hayashi
Atsushi Doi
Kenichi Sugioka
Minoru Yoshiyama
Publikationsdatum
01.08.2016
Verlag
Springer Japan
Erschienen in
Heart and Vessels / Ausgabe 3/2017
Print ISSN: 0910-8327
Elektronische ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-016-0882-2

Weitere Artikel der Ausgabe 3/2017

Heart and Vessels 3/2017 Zur Ausgabe

Screening-Mammografie offenbart erhöhtes Herz-Kreislauf-Risiko

26.04.2024 Mammografie Nachrichten

Routinemäßige Mammografien helfen, Brustkrebs frühzeitig zu erkennen. Anhand der Röntgenuntersuchung lassen sich aber auch kardiovaskuläre Risikopatientinnen identifizieren. Als zuverlässiger Anhaltspunkt gilt die Verkalkung der Brustarterien.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Adipositas-Medikament auch gegen Schlafapnoe wirksam

24.04.2024 Adipositas Nachrichten

Der als Antidiabetikum sowie zum Gewichtsmanagement zugelassene Wirkstoff Tirzepatid hat in Studien bei adipösen Patienten auch schlafbezogene Atmungsstörungen deutlich reduziert, informiert der Hersteller in einer Vorab-Meldung zum Studienausgang.

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.