Prevalence of drug-induced electrocardiographic pattern of the Brugada syndrome in a healthy population

To determine the prevalence of drug-induced Brugada's syndrome (BrS) electrocardiograms (ECGs) in a healthy population, a sodium channel blockade challenge was performed in previously identified subjects with BrS-compatible (BrC) ECGs. These subjects were detected in 1,000 normal patients in whom first ECGs were systematically recorded. Because of the intermittent nature of electrocardiographic modifications in BrS, second ECGs were also recorded in a representative sample of the population presenting with first ECGs with normal results. The prevalence of typical drug-induced BrS ECGs was 5 of the 1,000 patients. This value was fivefold greater than the reported prevalence of spontaneous BrS ECGs in the healthy population.     

Brugada syndrome phenotype cardiac arrest in a young patient unmasked during the acute phase of amiodarone infusion: disclosure and aggravation of Brugada electrocardiographic pattern

We report a case of an outpatient cardiac arrest due to ventricular fibrillation and resuscitated with external automated defibrillator shocks in which acute amiodarone infusion unmasked a Brugada phenotype electrocardiographic pattern. Possible interferences by this drug and suitable therapeutic actions are discussed.     

Current electrocardiographic criteria for diagnosis of Brugada pattern: a consensus report

Brugada syndrome is an inherited heart disease without structural abnormalities that is thought to arise as a result of accelerated inactivation of Na channels and predominance of transient outward K current (I(to)) to generate a voltage gradient in the right ventricular layers. This gradient triggers ventricular tachycardia/ventricular fibrillation possibly through a phase 2 reentrant mechanism. The Brugada electrocardiographic (ECG) pattern, which can be dynamic and is sometimes concealed, being only recorded in upper precordial leads, is the hallmark of Brugada syndrome. Because of limitations of previous consensus documents describing the Brugada ECG pattern, especially in relation to the differences between types 2 and 3, a new consensus report to establish a set of new ECG criteria with higher accuracy has been considered necessary. In the new ECG criteria, only 2 ECG patterns are considered: pattern 1 identical to classic type 1 of other consensus (coved pattern) and pattern 2 that joins patterns 2 and 3 of previous consensus (saddle-back pattern). This consensus document describes the most important characteristics of 2 patterns and also the key points of differential diagnosis with different conditions that lead to Brugada-like pattern in the right precordial leads, especially right bundle-branch block, athletes, pectus excavatum, and arrhythmogenic right ventricular dysplasia/cardiomyopathy. Also discussed is the concept of Brugada phenocopies that are ECG patterns characteristic of Brugada pattern that may appear and disappear in relation with multiple causes but are not related with Brugada syndrome.     

The incidence and prognosis of Brugada electrocardiographic pattern in the Manitoba Follow-Up Study

BACKGROUND: There is a paucity of long-term follow-up data on individuals with asymptomatic Brugada electrocardiographic (ECG) pattern. OBJECTIVES: To investigate the incidence and prognosis of spontaneous Brugada ECG pattern in a prospective cohort. METHODS: The Manitoba Follow-up Study is Canada's longest-running study of cardiovascular disease. Since 1948, a cohort of 3983 healthy aircrew recruits has been followed with routine medical examination, including ECG. Over a 55-year follow-up period, clinical and ECG assessments were performed every three to five years, with yearly contact to monitor vital status. The mean age of the cohort at entry and the average age of the 1375 survivors in 2003 were 31 and 83 years of age, respectively. Brugada ECG pattern was defined as ST-segment elevation in at least one of leads V1 to V3 with a J wave amplitude of at least 2 mm, negative T waves, generally coved ST-T configuration, in the absence of alternative explanations. Serial ECGs of 273 subjects (6.9% of the cohort) with complete right bundle branch block at any time during follow-up were reviewed. Follow-up records pertaining to clinical course were also reviewed. RESULTS: All ECGs (in total 5665) from this cohort were reviewed. Four men had intermittent Brugada ECG pattern (lifetime incidence one per 1000): three men (all 80 years of age or older) were well on last follow-up and one had died of Alzheimer's disease. None of these men had syncope or ventricular arrhythmias documented during follow-up. CONCLUSIONS: The longevity of asymptomatic individuals in this cohort was not affected by spontaneous Brugada ECG pattern.     

Prevalence and incidence of heart failure among community in China during a three-year follow-up

BACKGROUND Epidemiological surveys on heart failure(HF) in Chinese community are relatively lacking. This study aimed to estimate the prevalence and incidence of HF among community residents in southern China.METHODS Baseline data of this prospective study was collected from 2015 to 2017 among 12,013 permanent residents aged ≥ 35years in Guangzhou, China. The same survey process was carried out for individuals aged ≥ 65 years after a three-year follow-up.RESULTS The overall prevalence of HF in c...     

发热引起Brugada综合征样心电图改变一例及与发热有关的Brugada综合征文献复习

Brugada综合征的特异性心电图改变是诊断Brugada综合征的必要条件,可以时隐时现.但基础心电图正常,只在发热时表现出Brugada样心电图则少见,国内仅见2例发热时V1～V4导联ST段穹隆样抬高,体温正常后恢复正常心电图的报道.本院发现l例,现报道如下：     

Geriatric day hospital in Hong Kong: a three-year follow-up study

In this study, 477 elderly patients who attended the day hospital at Princess Margaret Hospital, Hong Kong in the years 1979-81 are reviewed. Our patients are on the whole younger than those in the UK, with an approximately equal sex ratio. The day hospital has an important function for the rehabilitation of stroke patients. A longer stay of patients has reflected the lack of day hospital places. A low New Patient Index resulted from the lack of day care centres.     

Prevalence and consequences of androgen deficiency in young male cancer survivors in a controlled cross-sectional study

BACKGROUND: Testosterone replacement in hypogonadal males improves body composition, sexual function, and health-related quality of life. Male cancer survivors are at risk of androgen deficiency; however, when and in whom testosterone should be replaced remain unanswered questions. OBJECTIVE: The aim of our study was to define the prevalence of androgen deficiency in this patient group through assessment of testosterone levels and related measures. DESIGN: This was a cross-sectional, observational study of cases and controls. We recruited 176 cancer survivors and 213 controls, aged 25-45 yr. RESULTS: Of cancer survivors, 97% had received chemotherapy and 40% radiotherapy. Cancer survivors had lower total testosterone (tT) levels than controls (mean difference 2.67 nmol/liter; 95% confidence interval 1.58-3.76; P = 0.003), and 24 of 176 (13.6%; 95% confidence interval 9.3-19.5) had a tT less than 10 nmol/liter, which was less than 2.5% centile for controls. Cancer survivors had a greater fat mass, higher fasting insulin and glucose levels, increased fatigue, and reduced sexual function and health-related quality of life. In both cohorts, the tT correlated negatively with insulin levels and negatively with body fat mass; however, the difference in tT between them was independent of fat mass. We measured tT and SHBG and calculated bioavailable testosterone. The changes in calculated bioavailable testosterone were similar to tT. CONCLUSIONS: A significant proportion of young male cancer survivors had a frankly low tT associated with an increased fat mass and insulin level compared with controls. These factors would be predicted to improve in response to testosterone replacement therapy and provide a powerful argument for an interventional study of testosterone therapy in young male cancer survivors.     

Incidence of Brugada electrocardiographic pattern and outcomes of these patients after intentional tricyclic antidepressant ingestion

Brugada syndrome is a genetic dysfunction of the myocardial sodium channel that leads to ventricular dysrhythmias. The electrocardiographic (ECG) pattern of Brugada syndrome is occasionally seen after tricyclic antidepressant (TCA) ingestion; however, the outcome and complication risk for these patients is not clear. The objective of our study was to describe the incidence of Brugada ECG pattern (BEP) and serious complications of these patients in a large case series of intentional TCA ingestions. We also compared the proportion of complications of patients with BEP versus those without BEP. We evaluated 402 TCA ingestions, of which 9 (2.3%) were associated with the development of BEP. We compared the adverse outcomes of all TCA ingestions versus TCA ingestions with BEP. A increase in the adverse outcomes in the BEP group was found: seizures (relative risk [RR] 4; 95% confidence interval [CI] 1.5 to 10.8), widened QRS (RR 4.8; 95% CI 1.8 to 12.9), and hypotension (RR 3.9; 95% CI 2.1 to 7.4). To reduce confounding ingestants, we also compared all patients with an isolated TCA ingestion versus those with BEP. A significant increase in adverse outcomes was again found with the BEP group: seizures (RR 3; 95% CI 1.1 to 8.6), widened QRS (RR 4.8; 95% CI 1.5 to 15.1), and hypotension (RR 3.4; 95% CI 1.9 to 22.3). No deaths or dysrhythmias were found in the BEP group. In conclusion, BEP after TCA ingestion is rare, and death or dysrhythmias did not occur. However, patients with BEP are likely at increased risk for TCA-induced complications.     

Continuous electrocardiographic recording during exercise in young male diabetics. A computer study.

Forty selected young patients with diabetes of medium to long duration and 26 control subjects without clinical evidence of ischaemic heart disease were studied using a new and sensitive technique of electrocardiographic recording during exercise with continuous computation of the time course of the ST-T segment changes to detect possible early ST depression indicative of ischaemia. Although no such evidence was found, significant differences in the diabetics were observed in the heart rate and ST-T segment, the latter changes having not been previously reported but which may be attributed to ischaemia or alternatively to autonomic neuropathy in the "presymptomatic" phase.     

Continuous electrocardiographic recording during exercise in young male diabetics. A computer study.

Forty selected young patients with diabetes of medium to long duration and 26 control subjects without clinical evidence of ischaemic heart disease were studied using a new and sensitive technique of electrocardiographic recording during exercise with continuous computation of the time course of the ST-T segment changes to detect possible early ST depression indicative of ischaemia. Although no such evidence was found, significant differences in the diabetics were observed in the heart rate and ST-T segment, the latter changes having not been previously reported but which may be attributed to ischaemia or alternatively to autonomic neuropathy in the "presymptomatic" phase.     

健康体检人群Brugada心电图征发生率的初步调查和随访

目的通过调查健康体检者Brugada心电图征的发生率,获得中国人Brugada心电图征的流行病学资料,并通过随访,了解Brugada心电图征人群的短期预后。方法收集了2003年6月至2005年1月我们医院查体中心健康体检人群45152份心电图资料,按照2002年欧洲心脏学会（ECS）专家共识报告提出的标准[1]筛选出Brugada心电图征。随访分两组:A组确诊为Brugada综合征患者（9人）,B组为无症状Brugada心电图阳性人群（73人）。结果共82人具有Brugada心电图征,占总数的1.82‰,其中男性73人,女性9人。Ⅰ型心电图征的18人,Ⅱ型38人,Ⅲ型26人,其中符合Brugada综合征共9人。随访结果:A组（24±12）个月的随访期内室性心动过速发生率为2/9,B组（27±11）个月的随访期内室性心动过速发生率为3%（2/73）,两组相比具有显著性差异（P<0.05）,两组人群均无人猝死。结论Brugada心电图征在广东省健康成年人发生率为1.82‰,男女比8∶1。在随访中发现,Brugada综合征患者要比无症状Brugada心电图征人群预后差,容易发生致命性的室性心律失常。     

Prevalence of electrocardiographic signs of pulmonary hypertension in a sample of male population of Novosibirsk

Prevalence of ECG signs of right ventricular hypertrophy and pulmonary hypertension was assessed in a representative sample (n=715) of nonorganized male population (age 25-64 years) of Novosibirsk studied within a framework of WHO MONICA project. Other methods of investigation included Rose questionnaire, anthropometry, ECG interpreted with Minnesota code, and echocardiography. Echocardiography data were used as reference for determination of sensitivity and specificity of ECG-criteria of pulmonary hypertension.     

Effects of body weight control on changes in blood pressure: three-year follow-up study in young Japanese individuals.

Numerous epidemiological studies have shown a close relationship between obesity and hypertension. However, there have been few reports on the relationship between changes in the body weight and blood pressure of lean to normal-weight young subjects. The purpose of this study was to investigate the effects of body weight control on blood pressure in lean to obese young Japanese individuals in a 3-year follow-up study. University students (3,558 males and 1,418 females, aged 18.6+/-0.8 in 1994) were classified into 4 groups according to the baseline body mass index (BMI), and were followed up for 3 years. Among male students, changes in body weight were significantly correlated with changes in blood pressure during the 3 years in all 4 BMI groups, and the correlation coefficient was larger in the group with higher baseline BMI. Positive correlations between changes in body weight and changes in heart rate were noted only in the obese and mildly-obese groups. Also in female students, positive correlations were observed between changes in body weight and changes in blood pressure in lean to obese groups. However, no correlations between changes in body weight and changes in heart rate were noted in any of the female groups. To summarize, close correlations were observed between changes in body weight and those in blood pressure during the 3 years in both male and female university students. These findings suggest the importance of body weight control not only in obese but also in normal to mildly-obese young subjects in reducing or preventing an increase in blood pressure. There could be, however, a gender difference in the effects of body weight change on heart rate.