title: Insight into specific pro-arrhythmic triggers in Brugada and early repolarization syndromes: results of long-term follow-up.
abstract: The pro-arrhythmic triggers in Brugada and early repolarization syndromes (BrS, ERS) have not been analyzed systematically except for case reports. We clinically investigated the circumstances which precede/predispose to arrhythmic events in these syndromes during long-term follow-up. A detailed history from the patients/witnesses was taken to investigate the antecedent events in the last few hours that preceded syncope/ventricular fibrillation (VF); medical records, ECG and blood test from the emergency room (ER) were reviewed. 19 patients that fulfilled the investigation criteria were followed up for 71 ± 49 months (34-190 months). Prior to the event (syncope/VF), the patients were partaking different activities in the following decreasing order; drinking alcoholic beverage, having meal, and getting up from sleep, exercise. 3 patients reported mental/physical stress prior to the event and 2 patients developed VF several days after starting oral steroid for treatment of bronchial asthma. In the ER, elevated J-wave amplitude (0.27 ± 0.15 mV) was found with 58 % of the patients having hypokalemia. After electrolyte correction and cessation of steroids, the following day plasma K+(4.2 ± 0.3 mEq/L, P < 0.001) was significantly increased and J-wave amplitude (0.13 ± 0.1 mV, P < 0.001) was remarkably reduced. Three patients were kept on oral spironolactone/potassium supplements. During follow-up for 71 ± 49 (34-190) months, among 4 patients with VF recurrence, one patient developed VF after taking oral steroid. In ERS and BrS, hypokalemia and corticosteroid therapy add substantial pro-arrhythmic effects, but potentially treatable. Stopping steroid therapy and avoiding hypokalemia had excellent long-term outcome.
authors.affiliation: Department of Cardiology, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan. ahmed@asahikawa-med.ac.jp.
authors.forename: Ahmed Karim
authors.initials: AK
authors.lastname: Talib
authors.affiliation: Department of Cardiology, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Sato
authors.affiliation: Department of Cardiology, Abashiri Kosei Hospital, Abashiri, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Myojo
authors.affiliation: Department of Cardiology, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Eitaro
authors.initials: E
authors.lastname: Sugiyama
authors.affiliation: Department of Cardiology, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Nakagawa
authors.affiliation: Department of Cardiology, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Naka
authors.initials: N
authors.lastname: Sakamoto
authors.affiliation: Department of Cardiology, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Tanabe
authors.affiliation: Department of Cardiology, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Fujino
authors.affiliation: Department of Cardiology, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Takeuchi
authors.affiliation: Department of Cardiology, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Akasaka
authors.affiliation: Department of Cardiology, Takikawa Municipal Hospital, Takikawa, Japan.
authors.forename: Hironobu
authors.initials: H
authors.lastname: Matsuhashi
authors.affiliation: Division of Community Medicine and Epidemiology, Department of Health Science, Asahikawa Medical University, Asahikawa, Japan.
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Saijo
authors.affiliation: Department of Cardiology, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Kawamura
authors.affiliation: Department of Cardiology, Asahikawa Red Cross Hospital, Asahikawa, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Doi
authors.affiliation: Department of Cardiology, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Hasebe
mesh_terms: D000200:Action Potentials; D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D053840:Brugada Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000187:drug effects / Q000503:physiopathology*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007008:Hypokalemia / Q000097:blood / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013575:Syncope / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000889:Anti-Arrhythmia Agents; D015415:Biomarkers; D011188:Potassium
keywords: Brugada syndrome; Early repolarization syndrome; Pro-arrhythmic triggers; Steroid