title: Vagal activity modulates spontaneous augmentation of ST elevation in the daily life of patients with Brugada syndrome.
abstract: BACKGROUND
  In Brugada syndrome, ventricular fibrillation (VF) occurs mainly during sleep, and Brugada ECG signs are intensified by parasympathomimetic drugs; therefore, vagal activity could be a precipitating factor of VF. The aim of the present study was to elucidate the relation between spontaneous augmentation of ST elevation and changes in autonomic nervous activities in the daily life of patients with Brugada syndrome.
  
  
  RESULTS
  Twenty-three consecutive patients with Brugada syndrome were studied. Group VF(+) consisted of 7 symptomatic patients and 3 asymptomatic patients with inducible VF; group VF(-) consisted of 13 asymptomatic patients without documented or inducible VF. Two-channel unipolar lead (V(1) and V(2)) Holter ECG was recorded. Heart rate variability was analyzed by the maximum entropy method. Spontaneous augmentation of ST elevation (>/=1.5 mm/20 min) occurred more frequently during 24 hours in group VF(+) than in group VF(-) (5.7 +/- 2.5 times vs 2.3 +/- 2.4 times, P < 0.01). ST elevation was significantly greater in group VF(+) than in group VF(-) (2.1 +/- 0.2 mm vs 1.8 +/- 0.2 mm, P < 0.05). Power of the high-frequency component (HF: 0.15-0.4 Hz) and RR interval increased progressively, and the ratio of low-frequency component (LF; 0.04- 0.15 Hz) to high-frequency component (LF/HF) gradually decreased toward the time of maximum ST elevation. During an entire day, daytime (0-5 P.M.), and nighttime (0-5 A.M.), both HF and LF/HF were not different between groups VF(+) and VF(-).
  
  
  CONCLUSIONS
  In Brugada syndrome, spontaneous augmentation of ST elevation in daily life occurred along with an increase in vagal activity. ST elevation was augmented more in patients with VF than in those without VF under similar vagal tone.
authors.affiliation: Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, Toyama, Japan. kmisu@ms.toyama-mpu.ac.jp
authors.forename: Koichi
authors.initials: K
authors.lastname: Mizumaki
authors.forename: Akira
authors.initials: A
authors.lastname: Fujiki
authors.forename: Takayuki
authors.initials: T
authors.lastname: Tsuneda
authors.forename: Masao
authors.initials: M
authors.lastname: Sakabe
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Nishida
authors.forename: Masataka
authors.initials: M
authors.lastname: Sugao
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Inoue
mesh_terms: D000328:Adult; D000368:Aged; D002037:Bundle-Branch Block / Q000503:physiopathology* / Q000628:therapy; D002940:Circadian Rhythm / Q000502:physiology; D017147:Defibrillators, Implantable; D015716:Electrocardiography, Ambulatory; D022062:Electrophysiologic Techniques, Cardiac; D006329:Heart Conduction System / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D013223:Statistics as Topic; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000503:physiopathology / Q000628:therapy