Mode of onset of ventricular fibrillation in patients with early repolarization pattern vs Brugada syndrome
Open accessAbstract
AIMS: The aim of the present study was to identify specific electrocardiogram (ECG) features that predict the development of multiple episodes of ventricular fibrillation (VF) in patients with an early repolarization (ER) pattern and to compare the mode of VF initiation with that observed in typical cases of Brugada syndrome (BrS). METHODS AND RESULTS: The mode of the onset and the coupling intervals of the premature ventricular contractions (PVCs) initiating VF episodes were analysed in patients with BrS (n = 8) or ER who experienced sudden cardiac death/syncope or repeated appropriate implantable cardioverter defibrillator shocks. Among the 11 patients with ER, 5 presented with electrical storm (ES, four or more recurrent VF episodes/day). The five ES patients displayed a dramatic but very transient accentuation of J waves across the precordial and limb leads prior to the development of ES. Ventricular fibrillation episodes were more commonly initiated by PVCs with a short-long-short (SLS) sequence in ER (42/58, 72.4%) vs. BrS patients (13/86, 15.1%, P < 0.01). Coupling intervals were significantly shorter in the ER group compared with those with BrS [328 (320, 340) ms vs. 395 (350, 404) ms, P < 0.01]. CONCLUSION: Our study provides additional evidence in support of the hypothesis that ER pattern in the ECG is not always benign. Transient augmentation of global J waves may be indicative of a highly arrhythmogenic substrate heralding multiple episodes of VF in patients with ER pattern. Ventricular tachycardia/VF initiation is more commonly associated with an SLS sequence, and PVCs display a shorter coupling interval in patients with ER pattern compared with those with BrS.
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- Authors
- Nam, G.-B., Ko, K.-H., Kim, J., Park, K.-M., Rhee, K.-S., Choi, K.-J., Kim, Y.-H., & Antzelevitch, C.
- Affiliations
- Asan Medical Center (KR)
- Pusan National University Hospital (KR)
- Inje University (KR)
- Jeonbuk National University Hospital (KR)
- Masonic Medical Research Laboratory (US)
- Corresponding author
- Nam, G.-B.
- Antzelevitch, C.
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-10-29
- Volume
- 31
- Issue
- 3
- Pages
- 330-339
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- PMC
- PMC2814221
- OpenAlex
- W2050644934
- Cited by
- 198
- References
- 30
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 4 · 2023: 4 · 2022: 8 · 2021: 3 · 2020: 10 · 2019: 5 · 2018: 10 · 2017: 17 · 2016: 19 · 2015: 11 · 2014: 16 · 2013: 32 · 2012: 22
- FWCI
- 11.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Heart Journal (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Institutes of Health (HL 47678)
- National Heart, Lung, and Blood Institute (HL-47678, R01HL047678)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Keywords
- ventricular fibrillation, early repolarization, Brugada syndrome, electrical storm, J wave, premature ventricular contractions, coupling interval, sudden cardiac death, implantable cardioverter-defibrillator shocks, ventricular tachycardia
- MeSH terms
- Adult, Aged, Cardiac Pacing, Artificial, Cardiotonic Agents, Electrocardiography, Female, Humans, Isoproterenol, Male, Middle Aged, Ventricular Fibrillation, Case-Control Studies, Brugada Syndrome, Young Adult
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