Significance of electrocardiogram recording in high intercostal spaces in patients with early repolarization syndrome.

Abstract

AIMS:

Published reports regarding inferolateral early repolarization (ER) syndrome (ERS) before 2013 possibly included patients with Brugada-pattern electrocardiogram (BrP-ECG) recorded only in the high intercostal spaces (HICS). We investigated the significance of HICS ECG recording in ERS patients.

METHODS AND RESULTS:

Fifty-six patients showing inferolateral ER in the standard ECG and spontaneous ventricular fibrillation (VF) not linked to structural heart disease underwent drug provocation tests by sodium channel blockade with right precordial ECG (V1-V3) recording in the 2nd-4th intercostal spaces. The prevalence and long-term outcome of ERS patients with and without BrP-ECG in HICS were investigated. After 18 patients showing type 1 BrP-ECG in the standard ECG were excluded, 38 patients (34 males, mean age; 40.4 ± 13.6 years) were classified into four groups [group A (n = 6;16%):patients with ER and type 1 BrP-ECG only in HICS, group B (n = 5;13%):ERS with non-type 1 BrP-ECG only in HICS, group C (n = 8;21%):ERS with non-type 1 BrP-ECG in the standard ECG, and group D (n = 19;50%):ERS only, spontaneously or after drug provocation test]. During follow-up of 110.0 ± 55.4 months, the rate of VF recurrence including electrical storm was significantly higher in groups A (4/6:67%), B (4/5:80%), and C (4/8:50%) compared with D (2/19:11%) (A, B, and C vs. D, P < 0.05).

CONCLUSIONS:

Approximately 30% of the patients with ERS who had been diagnosed with the previous criteria showed BrP-ECG only in HICS. Ventricular fibrillation mostly recurred in patients showing BrP-ECG in any precordial lead including HICS; these comprised 50% of the ERS cohort.

• Authors: Tsukasa Kamakura, Mitsuru Wada, Ikutaro Nakajima, Kohei Ishibashi, Koji Miyamoto, Hideo Okamura, Takashi Noda, Takeshi Aiba, Hiroshi Takaki, Satoshi Yasuda, Hisao Ogawa, Wataru Shimizu, Takeru Makiyama, Takeshi Kimura, Shiro Kamakura, Kengo Kusano
• Journal: European heart journal (Eur Heart J) Vol. 37 Issue 7 Pg. 630-7 (Feb 14 2016) ISSN: 1522-9645 [Electronic] England
• PMID: 26261291 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: [email protected].

Chemical References

• Anti-Arrhythmia Agents
• Lidocaine
• pilsicainide
• Flecainide

Topics

• Adult
• Anti-Arrhythmia Agents (pharmacology)
• Brugada Syndrome (complications, diagnosis)
• Electrocardiography
• Electrophysiologic Techniques, Cardiac (methods)
• Female
• Flecainide (pharmacology)
• Humans
• Lidocaine (analogs & derivatives, pharmacology)
• Male
• Prognosis
• Recurrence
• Risk Assessment
• Ventricular Fibrillation (diagnosis, etiology)