The full stomach test as a novel diagnostic technique for identifying patients at risk of Brugada syndrome.
BACKGROUND
Autonomic modulation, particularly high vagal tone, plays an important role in the occurrence of ventricular tachyarrhythmias in the Brugada syndrome. Food intake modulates vagal activity. We assessed the usefulness of a novel diagnostic technique, the "full stomach test," for identifying a high-risk group in patients with a Brugada-type electrocardiogram (ECG).


RESULTS
In 35 patients with a Brugada-type ECG, we assessed 12-lead ECGs before and after a large meal, a pilsicainide pharmacological test, spontaneous ST-segment change, late potentials by signal-averaged ECG, microvolt T-wave alternans, and four other ECG parameters. These patients were divided into two groups (i.e., high-risk group [n = 17] and indeterminate risk group [n = 18]). The full stomach test was defined as positive when augmentation of characteristic ECG abnormalities was observed after meals. Thirteen patients had a prior history of life-threatening events such as aborted sudden death and syncope, with a total of 30 episodes. These episodes had a circadian pattern, at night and after meals. The full stomach test was positive in 17 of the study patients (49%). A positive test outcome was characterized by a higher incidence of a history of life-threatening events than a negative test outcome (P = 0.015, odds ratio = 7.1). In comparison between the two groups, the incidence (82%) of positive outcomes in the high-risk group was significantly higher than that (17%) in the indeterminate risk group (P = 0.0002).


CONCLUSIONS
Characteristic ECG changes diagnostic of Brugada syndrome are augmented by a large meal. These data are associated with a history of life-threatening events in Brugada syndrome.
Ikeda
Takanori
T
Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan. iket@kyorin-u.ac.jp
Abe
Atsuko
A
Yusu
Satoru
S
Nakamura
Kentaro
K
Ishiguro
Haruhisa
H
Mera
Hisaaki
H
Yotsukura
Masayuki
M
Yoshino
Hideaki
H
D000328:Adult; D053840:Brugada Syndrome / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D002940:Circadian Rhythm; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006321:Heart / Q000294:innervation; D006801:Humans; D008012:Lidocaine / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D019518:Postprandial Period; D011237:Predictive Value of Tests; D026941:Sodium Channel Blockers; D013270:Stomach / Q000294:innervation; D013575:Syncope / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D014630:Vagus Nerve / Q000502:physiology; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology
D026941:Sodium Channel Blockers; D008012:Lidocaine; C042288:pilsicainide