Heart Rhythm
Volume 7, Issue 2 , Pages 218-224, February 2010

Atrial electrophysiological and structural remodeling in high-risk patients with Brugada syndrome: Assessment with electrophysiology and echocardiography

  • Norihisa Toh, MD

      Affiliations

    • Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
    • Corresponding Author InformationAddress reprint requests and correspondence: Dr. Norihisa Toh, Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Okayama City, Okayama 700-8558, Japan
    • ,
  • Hiroshi Morita, MD

      Affiliations

    • Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
    • ,
  • Satoshi Nagase, MD

      Affiliations

    • Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
    • ,
  • Manabu Taniguchi, MD

      Affiliations

    • Division of Cardiac Care Unit, Okayama University Hospital, Okayama, Japan
    • ,
  • Daiji Miura, PhD

      Affiliations

    • Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
    • ,
  • Nobuhiro Nishii, MD

      Affiliations

    • Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
    • ,
  • Kazufumi Nakamura, MD

      Affiliations

    • Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
    • ,
  • Tohru Ohe, MD, FHRS

      Affiliations

    • Department of Cardiology, Sakakibara Heart Institute of Okayama, Okayama, Japan
    • ,
  • Kengo F. Kusano, MD

      Affiliations

    • Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
    • ,
  • Hiroshi Ito, MD

      Affiliations

    • Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan

Received 26 August 2009; accepted 29 October 2009. published online 02 November 2009.

Background

Atrial fibrillation (AF) often occurs in Brugada syndrome (BrS), and BrS patients with spontaneous AF often experience ventricular fibrillation (VF) attacks. Atrial vulnerability providing a substrate for AF is known to be enhanced in BrS, but there are no data on atrial structural attributes.

Objective

The objective of this study was to assess atrial electrophysiological and structural characteristics in BrS and their relationships with gene mutations.

Methods

We studied 57 patients with BrS. Intra-atrial conduction time (CT) was defined as the interval from the stimulus at the high right atrium to atrial deflection at the distal portion of the coronary sinus. Left atrial volume index (LAVI) was measured by the modified Simpson method at left ventricular end-systole using echocardiography. SCN5A mutations were analyzed in all patients.

Results

In patients with documented VF, spontaneous AF frequently occurred and prolonged CT and increased LAVI were observed compared with those in patients without VF (all P < .05; LAVI: 22 ± 5 vs. 32 ± 7 ml/m2). Even among patients without AF, CT and LAVI were still increased in patients with VF (all P < .05; LAVI: 22 ± 5 vs. 29 ± 5 ml/m2). The presence of SCN5A mutation was associated with prolonged CT (P < .05) and increased LAVI (P < .01), but not with arrhythmic episodes.

Conclusion

Both atrial vulnerability and structural remodeling are enhanced in high-risk patients with BrS, even in those without AF. These morphological characteristics suggest that BrS is a form of genetic myocardial disease.

Keywords: Sudden cardiac death, Atrial fibrillation, Echocardiography, Genes, Remodeling

Abbreviations: AF, atrial fibrillation, BrS, Brugada syndrome, CD, conduction delay, CT, conduction time, ECG, electrocardiogram, ERP, effective refractory period, LA, left atrium/atrial, LAVI, left atrial volume index, LV, left ventricular, RAA, right atrial appendage, RAF, repetitive atrial firing, RVOT, right ventricular outflow tract, VF, ventricular fibrillation

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 The authors thank Yasuharu Tanabe, RDCS, and Nobuhisa Watanabe, RDCS, for obtaining the excellent echocardiographic data.

PII: S1547-5271(09)01221-1

doi:10.1016/j.hrthm.2009.10.035

Heart Rhythm
Volume 7, Issue 2 , Pages 218-224, February 2010

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