title: Repolarization characteristics in early repolarization and brugada syndromes: insight into an overlapping mechanism of lethal arrhythmias.
abstract: BACKGROUND
  We reported impaired QT-rate dependence in early repolarization syndrome (ERS); however, contemporary data have shown peak incidence of sudden cardiac death (SCD) in ERS and Brugada syndrome (BrS) at mid-night and early morning. Taken together, we analyzed the nocturnal QT-rate dependence in both syndromes.
  
  
  RESULTS
  A total of 172 subjects were enrolled: 11 ERS, 11 BrS patients, 50 subjects with an uneventful ER pattern (ERP), and 100 non-J-wave control subjects. Ambulatory ECG-derived parameters (QT, QTc, and QT/RR slope) and day-night QT difference were analyzed and compared. Among the groups, there was no significant difference in the average QT or QTc; however, the 24-hour QT/RR slope was significantly smaller in ERS and BrS patients (0.103 ± 0.01 and 0.106 ± 0.01, respectively) than in the control group (0.156 ± 0.03, P < 0.001). Detailed analysis showed a lower day-night QT difference in ERS and BrS patients (19 ±18.7 and 24 ±14 milliseconds, respectively) than in the controls (40 ± 22 milliseconds, P = 0.007) with the lowest QT/RR slopes seen in the ERS and BrS groups from 0 to 3:00 am (QT/RR; 0.076 ± 0.02 vs. 0.092 ± 0.04 vs. 0.117 ± 0.04, for the ERS, BrS, and controls, respectively, P = 0.004) and from 3 to 6 am (QT/RR 0.074 ± 0.03 vs. 0.079 ± 0.02 vs. 0.118 ± 0.04, P < 0.001).
  
  
  CONCLUSIONS
  In a large population of age- and gender-matched groups, both ERS and BrS patients showed attenuated QT-rate dependence and impaired QT day-night modulation that may provide a baseline reentrant substrate. Importantly, QT/RR maladaptation was most evident at mid-night and early morning, which may explain the propensity of such patients to develop SCD during this critical period.
authors.affiliation: Department of Cardiology, Asahikawa Medical University, Asahikawa, Japan.
authors.forename: Ahmed Karim
authors.initials: AK
authors.lastname: Talib
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Sato
authors.forename: Naoko
authors.initials: N
authors.lastname: Kawabata
authors.forename: Eitaro
authors.initials: E
authors.lastname: Sugiyama
authors.forename: Naka
authors.initials: N
authors.lastname: Sakamoto
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Tanabe
authors.forename: Takayuki
authors.initials: T
authors.lastname: Fujino
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Takeuchi
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Saijo
authors.forename: Kazumi
authors.initials: K
authors.lastname: Akasaka
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Kawamura
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Hasebe
mesh_terms: D017677:Age Distribution; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000401:mortality*; D053840:Brugada Syndrome / Q000175:diagnosis* / Q000401:mortality*; D002940:Circadian Rhythm; D015897:Comorbidity; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D015716:Electrocardiography, Ambulatory / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D015996:Survival Rate
keywords: Brugada syndrome; QT dynamics; QT interval; early repolarization syndrome; sudden death