Clinical impact of the number of extrastimuli in programmed electrical stimulation in patients with Brugada type 1 electrocardiogram

Heart Rhythm. 2012 Feb;9(2):242-8. doi: 10.1016/j.hrthm.2011.09.053. Epub 2011 Sep 20.

Abstract

Background: Use of programmed electrical stimulation (PES) for risk stratification of Brugada syndrome (BrS) is controversial.

Objective: To elucidate the role of the number of extrastimuli during PES in patients with BrS.

Methods: Consecutive 108 patients with type 1 electrocardiogram (104 men, mean age 46 ± 12 years; 26 with ventricular fibrillation [VF], 40 with syncope, and 42 asymptomatic) underwent PES with a maximum of 3 extrastimuli from the right ventricular apex and the right ventricular outflow tract. Ventricular arrhythmia (VA) was defined as VF or nonsustained polymorphic ventricular tachycardia >15 beats. Patients with VA induced by a single extrastimulus or double extrastimuli were assigned to group SD (Single/Double), by triple extrastimuli to group T (Triple), and the remaining patients to group N.

Results: VA was induced in 81 patients (VF in 71 and polymorphic ventricular tachycardia in 10), in 4 by a single extrastimulus, in 41 by double extrastimuli, and in 36 by triple extrastimuli. During 79 ± 48 months of follow-up, 24 patients had VF events. Although the overall inducibility of VA was not associated with an increased risk of VF (log-rank P = .78), group SD had worse prognosis than did group T (P = .004). Kaplan-Meier analysis in patients without prior VF also showed that group SD had poorer outcome than did group T and group N (P = .001). Positive and negative predictive values of VA induction with up to 2 extrastimuli were, respectively, 36% and 87%, better than those with up to 3 (23% and 81%, respectively).

Conclusions: The number of extrastimuli that induced VA served as a prognostic indicator for patients with Brugada type 1 electrocardiogram. Single extrastimulus or double extrastimuli were adequate for PES of patients with BrS.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Brugada Syndrome / complications
  • Brugada Syndrome / physiopathology*
  • Electrocardiography
  • Electrophysiologic Techniques, Cardiac / methods*
  • Female
  • Follow-Up Studies
  • Heart Ventricles / physiopathology*
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Risk Assessment
  • Tachycardia, Ventricular / etiology
  • Tachycardia, Ventricular / physiopathology*
  • Ventricular Fibrillation / etiology
  • Ventricular Fibrillation / physiopathology*