Background
Patients with early repolarization syndrome (ERS) and Brugada syndrome (BruS) have
comparable clinical symptoms. In both conditions, ventricular fibrillation (VF) is
experienced often near midnight or in the early morning hours when the parasympathetic
tone is augmented. However, differences between ERS and BruS regarding the risk of
VF occurrence have recently been reported. The role of vagal activity remains especially
unclear.
Objective
The goal of this study was to determine the relationship between VF occurrence and
autonomic nervous activity in patients with ERS and BruS.
Methods
We enrolled 50 patients with ERS (n = 16) and BruS (n = 34) who received an implantable
cardioverter-defibrillator. Of these, 20 patients (5 ERS and 15 BruS) experienced
VF recurrence (recurrent VF group). We investigated baroreflex sensitivity (BaReS)
with the phenylephrine method and heart rate variability using Holter electrocardiography
in all patients to estimate autonomic nervous function.
Results
In both patients with ERS and BruS, there was no significant difference in heart rate
variability between the recurrent VF and nonrecurrent VF groups. However, in patients
with ERS, BaReS was significantly higher in the recurrent VF group than in the nonrecurrent
VF group (P = .03); this difference was not evident in patients with BruS. High BaReS was independently
associated with VF recurrence in patients with ERS according to Cox proportional hazards
regression analyses (hazard ratio 1.52; 95% confidence interval 1.031–3.061; P = .032).
Conclusion
Our findings suggest that in patients with ERS, an exaggerated vagal response, as
represented by increased BaReS indices, may be involved in the risk of VF occurrence.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: March 02, 2023
Publication stage
In Press Journal Pre-ProofFootnotes
Funding Sources: This work was supported in part by the Japanese Ministry of Education, Science and Culture (Grant-in-Aid 15K08180, to Dr Shinohara).
Disclosures: The authors have no conflicts of interest to disclose.
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