title: Enhancement of J-ST-segment elevation by the glucose and insulin test in Brugada syndrome.
abstract: The effects of glucose and insulin on J-ST-segment elevation were evaluated in seven men (mean age 45 +/- 10 years) with Brugada syndrome. Six patients had been reanimated from VF and one patient had experienced syncope. The effects of intavenous (1) pilsicainide 50 mg, (2) glucose 50 g, and (3) glucose 50 g plus regular insulin 10 IU on the precordial ECG leads were examined. Pilsicainide significantly enhanced J-ST elevation in all patients and induced VF in 1 patient. A significant accentuation of the abnormal J-ST configuration was observed in all patients at a mean of 51 +/- 40 minutes after glucose and insulin infusion. Changes in blood glucose and serum potassium concentration were 111 +/- 158 mg/dL and -0.30 +/- 0.48 mEq/L, respectively. These changes were not directly related to the ECG changes. Glucose infusion without insulin caused a subtle increase in J-ST elevation. In conclusion, the administration of glucose and insulin safely unmasked or accentuation the J-ST-segment elevation in Brugada syndrome. Blood glucose and insulin concentrations may be factors modulating the circadian or day-to-day ECG variations in this syndrome.
authors.affiliation: Div. of Cardiology, Yokohama Rosai Hospital, 3211 Kozukue, Kohoku, Yokohama, Kanagawa 222-0036, Japan. akihiko-ind@umin.ac.jp
authors.forename: Akihiko
authors.initials: A
authors.lastname: Nogami
authors.forename: Motohiro
authors.initials: M
authors.lastname: Nakao
authors.forename: Shoichi
authors.initials: S
authors.lastname: Kubota
authors.forename: Aiko
authors.initials: A
authors.lastname: Sugiyasu
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Doi
authors.forename: Ken
authors.initials: K
authors.lastname: Yokoyama
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Yumoto
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Tamaki
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Kato
authors.forename: Noriyo
authors.initials: N
authors.lastname: Hosokawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sagai
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakamura
authors.forename: Jun-Ichi
authors.initials: J
authors.lastname: Nitta
authors.forename: Yasuteru
authors.initials: Y
authors.lastname: Yamauchi
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
mesh_terms: D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000494:pharmacology; D002037:Bundle-Branch Block / Q000503:physiopathology*; D004562:Electrocardiography / Q000187:drug effects*; D005947:Glucose / Q000494:pharmacology*; D006323:Heart Arrest; D006801:Humans; D007328:Insulin / Q000494:pharmacology*; D008012:Lidocaine / Q000031:analogs & derivatives* / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D013575:Syncope; D013577:Syndrome; D014693:Ventricular Fibrillation
chemical_list: D000889:Anti-Arrhythmia Agents; D007328:Insulin; D008012:Lidocaine; C042288:pilsicainide; D005947:Glucose