Prevalence and characteristics of the Brugada electrocardiogram pattern in patients with arrhythmogenic right ventricular cardiomyopathy.

Nobuhiko Ueda,Chisato Izumi,Satoshi Nagase,Naoya Kataoka,Kenichiro Yamagata,Kohei Ishibashi,Takashi Noda,Takeshi Aiba,Kengo Kusano,Tsukasa Kamakura,Yuko Inoue,Seiko Ohno,Kenzaburo Nakajima,Teruo Noguchi,Koji Miyamoto,Mitsuru Wada

doi:10.1002/joa3.12628

Abstract

BackgroundDespite distinct pathophysiology, arrhythmogenic right ventricular cardiomyopathy (ARVC) and Brugada syndrome (BrS) exhibit overlapping phenotypes. We investigated the prevalence and characteristics of the Brugada electrocardiogram (ECG) pattern in ARVC patients.MethodsA total of 114 ARVC patients fulfilling the revised Task Force Criteria were enrolled. The Brugada ECG pattern was evaluated according to the consensus report on right precordial leads, and 1141 ECGs (median, 1; interquartile range, 1‐16 ECGs/patient) were analyzed.ResultsFive patients (4%) showed a Brugada ECG pattern, which disappeared in four patients with ECGs recorded more than 2 years afterward. ARVC patients with the Brugada ECG pattern had a longer PQ interval (220 ± 62 ms vs 180 ± 35 ms, P = .02) and longer QRS duration (138 ± 25 ms vs 102 ± 23 ms, P < .001) than patients without the pattern. During follow‐up (median, 11.4; interquartile range, 5.5‐17.1 years), 19 ARVC patients experienced cardiac death and 29 experienced heart failure (HF) hospitalization. Kaplan‐Meier analysis determined that the Brugada ECG pattern increased the risk of cardiac death and HF hospitalization (log‐rank; P < .001, P < .001 respectively). The mean J‐point and S‐wave amplitudes of the Brugada ECG pattern were 0.29 ± 0.05 mV and 0.34 ± 0.21 mV, respectively, which were significantly lower than those of 26 age‐matched BrS patients with a previous ventricular fibrillation episode (0.66 ± 0.33 mV, P < .001 and 0.67 ± 0.39 mV, P = .02 respectively).ConclusionThe Brugada ECG pattern was infrequently encountered, was transient in ARVC patients, and was associated with a longer PQ interval, longer QRS duration, and cardiac events.

Highlights

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a myocardial disorder characterized by the morphological features of increased dimensions and wall motion abnormalities in the right ventricle (RV), fibrofatty replacement of the myocardium predominantly from RV subepicardium, and fatal ventricular arrhythmia (VA).[1]
The Brugada ECG pattern in arrhythmogenic right ventricular cardiomyopathy (ARVC) patients was associated with a longer PQ interval, longer QRS duration, and cardiac events, including cardiac death and heart failure (HF) hospitalization
This study showed that the Brugada ECG pattern was associated with a longer PQ interval, longer QRS duration, and cardiac events, including cardiac death and HF hospitalization, in ARVC patients

Summary

Conclusion

The Brugada ECG pattern was infrequently encountered, was transient in ARVC patients, and was associated with a longer PQ interval, longer QRS duration, and cardiac events. KEYWORDS arrhythmogenic right ventricular cardiomyopathy, Brugada syndrome, cardiac death, depolarization abnormality, heart failure

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