Prognostic value of right ventricular refractory period heterogeneity in Type-1 Brugada electrocardiographic pattern. Issue 2 (5th October 2022)

• Record Type: Journal Article
• Authors: Rossi, Andrea; Giannoni, Alberto; Nesti, Martina; Notarstefano, Pasquale; Castiglione, Vincenzo; Solarino, Gianluca; Teresi, Lucio; Mirizzi, Gianluca; Russo, Vincenzo; Panchetti, Luca; Startari, Umberto; Ripoli, Andrea; Gentile, Francesco; Santoro, Amato; Botto, Nicoletta; Casolo, Giancarlo; Sieira, Juan; Pieroni, Maurizio; Santangeli, Pasquale; Emdin, Michele; Piacenti, Marcello
• Is Part Of: Europace. Volume 25:Issue 2(2023)
• Page Start: 651
• Page End: 659
• Publication Date: 2022-10-05
• Subjects: Brugada syndrome -- Sudden cardiac death -- Electrophysiological study -- Refractory period; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euac168
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Aims: To investigate the prognostic significance of heterogeneity in the refractoriness of right ventricular (RV) outflow tract (RVOT) and RV apex at the electrophysiological study (EPS) in Brugada syndrome (BrS). Methods and results: A cohort of BrS patients (primary prevention) from five Italian centres was retrospectively analysed. Patients with spontaneous or drug-induced Type-1 electrocardiogram (ECG) + symptoms were offered an EPS for prognostic stratification. The primary endpoint was a composite of sudden cardiac death (SCD), resuscitated cardiac arrest, or appropriate intervention by the implantable cardioverter-defibrillator (ICD). Three hundred and seventy-two patients with BrS were evaluated (44 ± 15 years, 69% males, 23% with ICD): 4 SCDs and 17 ICD interventions occurred at follow-up (median 48, interquartile range: 36–60 months). Family history of SCD, syncope, and a spontaneous Type-1 ECG pattern were univariate predictors of the primary endpoint in the whole population. In patients undergoing EPS ( n = 198, 53%, 44 ± 12 years, 71% males, 39% with ICD), 3 SCD and 15 ICD interventions occurred at follow-up. In this subset, the primary endpoint was not only predicted by ventricular tachycardia/fibrillation inducibility but also by a difference in the refractory period between RVOT and RV apex (ΔRPRVOT-apex ) >60 ms. ΔRPRVOT-apex > 60 ms remained an independent predictor of SCD/ICD shock at bivariate analysis, even when adjusted for the other univariate predictors, showing the highest predictive power at C-statistic analysis (0.75, 95% confidence interval 0.63–0.86). Conclusions: Heterogeneity of RV refractory periods is a strong, independent predictor of life-threatening arrhythmias in BrS patients, beyond VT/VF inducibility at EPS and common clinical predictors. Graphical Abstract: Graphical Abstract In patients with Type-1 ECG Brugada pattern, the presence of an increased difference in the refractoriness between the right ventricular outflow tract (RVOT) and the apex, mainly driven by an increased refractory period in the RVOT, increases the prognostic discrimination power of the electrophysiological study, currently based only on inducibility of life-threatening arrhythmias. BrS, Brugada syndrome; EPS, electrophysiological study; RP, refractory period; RV, right ventricle; RVOT, right ventricular outflow tract; VF, ventricular fibrillation; VT, ventricular tachycardia.