title: Prolonged right ventricular ejection delay identifies high risk patients and gender differences in Brugada syndrome.
abstract: OBJECTIVE
  Right ventricular (RV) conduction delay has been suggested as an underlying pathophysiological mechanism in Brugada syndrome (BS). In this cross-sectional study we non-invasively assessed the value of echocardiographic markers reflecting ventricular ejection delay to further assess electromechanical abnormalities in BS and to identify patients at risk for life-threatening arrhythmic events. Furthermore, we sought to assess differences in ejection delays between genders because male BS patients demonstrate a more malignant clinical phenotype.
  
  
  METHODS
  124 BS patients (57.3% males) and 62 controls (CTR) (48.4% males) were included. Using Tissue Velocity Imaging, the ejection delay, determined as the time from QRS onset to the onset of the sustained systolic contraction, was measured for both RV free wall (RVED) and lateral LV wall (LVED). From these parameters, the interventricular ejection delay between both walls (IVED) was calculated.
  
  
  RESULTS
  BS patients had longer RVEDs and IVEDs compared to the CTR. BS patients with a previous history of syncope or spontaneous ventricular arrhythmia showed the longest RVEDs and IVEDs. Male BS patients demonstrated longer RVEDs and IVEDs than females. Male BS patients with malignant events had the longest delays. No significant differences regarding LVED were observed between BS patients and CTR.
  
  
  CONCLUSIONS
  We demonstrated that a previous history of malignant events was associated with longer RVEDs. Our findings supported the RV conduction delay mechanism behind BS and demonstrated for the first time that the predominant malignant male Brugada phenotype might also be the result of a more delayed RV conduction in males.
authors.affiliation: Department of Electrophysiology (Heart Rhythm Management Centre), Vrije Universiteit Brussel (VUB), UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium; Department of Electrophysiology, Thoraxcenter, Erasmus MC, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.. Electronic address: s.vanmalderen@erasmusmc.nl.
authors.forename: Sophie C H
authors.initials: SC
authors.lastname: Van Malderen
authors.affiliation: Department of Non-invasive Cardiology, Vrije Universiteit Brussel (VUB), UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: Kerkhove
authors.affiliation: Department of Electrophysiology, Thoraxcenter, Erasmus MC, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
authors.forename: Dominic A M J
authors.initials: DA
authors.lastname: Theuns
authors.affiliation: Department of Non-invasive Cardiology, Vrije Universiteit Brussel (VUB), UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Caroline
authors.initials: C
authors.lastname: Weytjens
authors.affiliation: Department of Non-invasive Cardiology, Vrije Universiteit Brussel (VUB), UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: Droogmans
authors.affiliation: Department of Cardiac Radiology, Vrije Universiteit Brussel (VUB), UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Centre for Medical Genetics, Reproduction and Genetics, Reproduction Genetics and Regenerative Medicine, Vrije Universiteit Brussel (VUB), UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Dorien
authors.initials: D
authors.lastname: Daneels
authors.affiliation: Centre for Medical Genetics, Reproduction and Genetics, Reproduction Genetics and Regenerative Medicine, Vrije Universiteit Brussel (VUB), UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Sonia
authors.initials: S
authors.lastname: Van Dooren
authors.affiliation: Centre for Medical Genetics, Reproduction and Genetics, Reproduction Genetics and Regenerative Medicine, Vrije Universiteit Brussel (VUB), UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Marije
authors.initials: M
authors.lastname: Meuwissen
authors.affiliation: Centre for Medical Genetics, Reproduction and Genetics, Reproduction Genetics and Regenerative Medicine, Vrije Universiteit Brussel (VUB), UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Maryse
authors.initials: M
authors.lastname: Bonduelle
authors.affiliation: Department of Electrophysiology (Heart Rhythm Management Centre), Vrije Universiteit Brussel (VUB), UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Pedro
authors.initials: P
authors.lastname: Brugada
authors.affiliation: Department of Non-invasive Cardiology, Vrije Universiteit Brussel (VUB), UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Guy
authors.initials: G
authors.lastname: Van Camp
mesh_terms: D000328:Adult; D053840:Brugada Syndrome / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D013318:Stroke Volume / Q000502:physiology*; D016278:Ventricular Function, Right / Q000502:physiology*
keywords: Brugada Syndrome; Conduction delay; Gender; SCN5A; Syncope; Tissue Velocity Imaging