Skip to main content
SpringerLink
Log in

The utility of T-wave alternans during the morning in the summer for the risk stratification of patients with Brugada syndrome

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

The prognostic value of the seasonal variations of T-wave alternans (TWA) and heart rate variability (HRV), and the seasonal distribution of ventricular fibrillation (VF) in Brugada syndrome (Br-S) is unknown. We assessed the utility of seasonal variations in TWA and HRV for risk stratification in Br-S using a 24-h multichannel Holter electrocardiogram (24-M-ECG). We enrolled 81 patients with Br-S (grouped according to their history of VF, n = 12; syncope, n = 8; no symptoms, n = 61) who underwent 24-M-ECG in all four seasons. Precordial electrodes were attached to the third (3L-V2) and fourth (4L-V2, 4L-V5) intercostal spaces. We determined the maximum TWA (max-TWA) values and calculated HRV during night and morning time periods for all seasons. During a follow-up period of 5.8 ± 2.8 years, 11 patients experienced new VF episodes and there was a peak in new VF episodes in the summer. The VF group had the greatest 3L-V2 max-TWA value during morning time in the summer among the three groups and showed higher 3L-V2 max-TWA value than in the other seasons. The cutoff value for the 3L-V2 max-TWA during morning time in the summer was determined to be 42 µV using ROC analysis (82 % sensitivity, 74 % specificity; p = 0.0006). Multivariate analysis revealed that a 3L-V2 max-TWA value ≥42 µV during morning time in the summer and previous VF episodes were predictors of future VF episodes. The 3L-V2 max-TWA value during morning time in the summer may be a useful predictor of future VF episodes in Br-S.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Brugada R, Campuzano O, Sarquella-Brugada G, Brugada J, Brugada P (2014) Brugada syndrome. Methodist DeBakey Cardiovasc J 10:25–28

    Article  PubMed  PubMed Central  Google Scholar 

  2. Talib AK, Sato N, Myojo T, Sugiyama E, Nakagawa N, Sakamoto N, Tanabe Y, Fujino T, Takeuchi T, Akasaka K, Matsuhashi H, Saijo Y, Kawamura Y, Doi A, Hasebe N (2016) Insight into specific pro-arrhythmic triggers in Brugada and early repolarization syndromes: results of long-term follow-up. Heart Vessels. doi:10.1007/s00380-016-0828-8

    PubMed  Google Scholar 

  3. Talib AK, Sato N, Kawabata N, Sugiyama E, Sakamoto N, Tanabe Y, Fujino T, Takeuchi T, Saijo Y, Akasaka K, Kawamura Y, Hasebe N (2014) Repolarization characteristics in early repolarization and Brugada syndromes: insight into an overlapping mechanism of lethal arrhythmias. J Cardiovasc Electrophysiol 25:1376–1384

    PubMed  Google Scholar 

  4. Kim SH, Nam GB, Baek S, Choi HO, Kim KH, Choi KJ, Joung B, Pak HN, Lee MH, Kim SS, Park SJ, On YK, Kim JS, Oh IY, Choi EK, Oh S, Choi YS, Choi JI, Park SW, Kim YH, Lee MY, Lim HE, Lee YS, Cho Y, Kim J, Lee DI, Cho DK, Kim YH (2012) Circadian and seasonal variations of ventricular tachyarrhythmias in patients with early repolarization syndrome and Brugada syndrome: analysis of patients with implantable cardioverter defibrillator. J Cardiovasc Electrophysiol 23:757–763

    Article  PubMed  Google Scholar 

  5. Takigawa M, Noda T, Shimizu W, Miyamoto K, Okamura H, Satomi K, Suyama K, Aihara N, Kamakura S, Kurita T (2008) Seasonal and circadian distributions of ventricular fibrillation in patients with Brugada syndrome. Heart Rhythm 5:1523–1527

    Article  PubMed  Google Scholar 

  6. Uchimura-Makita Y, Nakano Y, Tokuyama T, Fujiwara M, Watanabe Y, Sairaku A, Kawazoe H, Matsumura H, Oda N, Ikanaga H, Motoda C, Kajihara K, Oda N, Verrier RL, Kihara Y (2014) Time-domain T-wave alternans is strongly associated with a history of ventricular fibrillation in patients with Brugada syndrome. J Cardiovasc Electrophysiol 25:1021–1027

    Article  PubMed  Google Scholar 

  7. Tobaldini E, Brugada J, Benito B, Molina I, Montserrat J, Kara T, Leinveber P, Porta A, Macedo PG, Montano N, Somers VK (2013) Cardiac autonomic control in Brugada syndrome patients during sleep: cardiac autonomic control in Brugada syndrome patients during sleep: the effects of sleep disordered breathing. Int J Cardiol 168:3267–3272

    Article  PubMed  Google Scholar 

  8. Priori SG, Wilde AA, Horie M, Cho Y, Behr ER, Berul C, Blom N, Brugada J, Chiang CE, Huikuri H, Kannankeril P, Krahn A, Leenhardt A, Moss A, Schwartz PJ, Shimizu W, Tomaselli G, Tracy C, Ackerman M, Belhassen B, Estes NA 3rd, Fatkin D, Kalman J, Kaufman E, Kirchhof P, Schulze-Bahr E, Wolpert C, Vohra J, Refaat M, Etheridge SP, Campbell RM, Martin ET, Quek SC (2013) Executive summary: HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes. Europace 15:1389–1406

    Article  PubMed  Google Scholar 

  9. JCS Joint Working Group (2012) Guidelines for risks and prevention of sudden cardiac death (JCS 2010): digest version. Circ J 76:489–507

    Article  Google Scholar 

  10. Verrier RL, Klingenheben T, Malik M, El-Sherif N, Exner DV, Hohnloser SH, Ikeda T, Martinez JP, Narayan SM, Nieminen T, Rosenbaum DS (2011) Microvolt T-wave alternans physiological basis, methods of measurement, and clinical utility-consensus guideline by International Society for Holter and Noninvasive Electrocardiology. J Am Coll Cardiol 58:1309–1324

    Article  PubMed  PubMed Central  Google Scholar 

  11. Takasugi N, Nishigaki K, Kubota T, Tsuchiya K, Natsuyama K, Takasugi M, Nawa T, Ojio S, Aoyama T, Kawasaki M, Takemura G, Minatoguchi S (2009) Sleep apnoea induces cardiac electrical instability assessed by T-wave alternans in patients with congestive heart failure. Eur J Heart Fail 11:1063–1070

    Article  PubMed  Google Scholar 

  12. Hermida JS, Leenhardt A, Cauchemez B, Denjoy I, Jarry G, Mizon F, Milliez P, Rey JL, Beaufils P, Coumel P (2003) Decreased nocturnal standard deviation of averaged NN intervals. An independent marker to identify patients at risk in the Brugada syndrome. Eur Heart J 24:2061–2069

    Article  PubMed  Google Scholar 

  13. Kirchhof P, Eckardt L, Rolf S, Esperer HD, Paul M, Wichter T, Klein HU, Breithardt G, Bocker D (2004) T wave alternans does not assess arrhythmic risk in patients with Brugada syndrome. Ann Noninvasive Electrocardiol 9:162–165

    Article  PubMed  Google Scholar 

  14. Ikeda T, Takami M, Sugi K, Mizusawa Y, Sakurada H, Yoshino H (2005) Noninvasive risk stratification of subjects with a Brugada-type electrocardiogram and no history of cardiac arrest. Ann Noninvasive Electrocardiol 10:396–403

    Article  PubMed  Google Scholar 

  15. Kawazoe H, Nakano Y, Ochi H, Takagi M, Hayashi Y, Uchimura Y, Tokuyama T, Watanabe Y, Matsumura H, Tomomori S, Sairaku A, Suenari K, Awazu A, Miwa Y, Soejima K, Chayama K, Kihara Y (2016) Risk stratification of ventricular fibrillation in brugada syndrome using noninvasive scoring methods. Heart Rhythm. doi:10.1016/j.hrthm.2016.07.009

  16. Sakamoto S, Takagi M, Tatsumi H, Doi A, Sugioka K, Hanatani A, Yoshiyama M (2016) Utility of T-wave alternans during night time as a predictor for ventricular fibrillation in patients with Brugada syndrome. Heart Vessels 31:947–956

    Article  PubMed  Google Scholar 

  17. Morita H, Zipes DP, Morita ST, Wu J (2007) Differences in arrhythmogenicity between the canine right ventricular outflow tract and anteroinferior right ventricle in a model of Brugada syndrome. Heart Rhythm 4:66–74

    Article  PubMed  Google Scholar 

  18. Yamasaki H, Tada H, Sekiguchi Y, Aonuma K (2015) Right coronary cusp as a new window of ablation for pilsicainide-induced ventricular premature contractions in a patient with Brugada syndrome. Heart Vessels. doi:10.1007/s00380-015-0760-3

    Google Scholar 

  19. Shimeno K, Takagi M, Maeda K, Tatsumi H, Doi A, Nakagawa E, Yoshiyama M (2009) Usefulness of multichannel Holter ECG recording in the third intercostal space for detecting type 1 Brugada ECG: comparison with repeated 12-lead ECGs. J Cardiovasc Electrophysiol 20:1026–1031

    Article  PubMed  Google Scholar 

  20. Delise P, Allocca G, Marras E, Giustetto C, Gaita F, Sciarra L, Calo L, Proclemer A, Marziali M, Rebellato L, Berton G, Coro L, Sitta N (2011) Risk stratification in individuals with the Brugada type 1 ECG pattern without previous cardiac arrest: usefulness of a combined clinical and electrophysiologic approach. Eur Heart J 32:169–176

    Article  PubMed  Google Scholar 

  21. Nakano Y, Shimizu W, Ogi H, Suenari K, Oda N, Makita Y, Kajihara K, Hirai Y, Sairaku A, Tokuyama T, Tonouchi Y, Ueda S, Sueda T, Chayama K, Kihara Y (2010) A spontaneous type 1 electrocardiogram pattern in lead V2 is an independent predictor of ventricular fibrillation in Brugada syndrome. Europace 12:410–416

    Article  PubMed  Google Scholar 

  22. Antzelevitch C, Brugada P, Brugada J, Brugada R, Shimizu W, Gussak I, Perez Riera AR (2002) Brugada syndrome: a decade of progress. Circ Res 91:1114–1118

    Article  CAS  PubMed  Google Scholar 

  23. Kruse HJ, Wieczorek I, Hecker H, Creutzig A, Schellong SM (2002) Seasonal variation of endothelin-1, angiotensin II, and plasma catecholamines and their relation to outside temperature. J Lab Clin Med 140:236–241

    Article  CAS  PubMed  Google Scholar 

  24. Matsuo K, Kurita T, Inagaki M, Kakishita M, Aihara N, Shimizu W, Taguchi A, Suyama K, Kamakura S, Shimomura K (1999) The circadian pattern of the development of ventricular fibrillation in patients with Brugada syndrome. Eur Heart J 20:465–470

    Article  CAS  PubMed  Google Scholar 

  25. Nishida K, Fujiki A, Mizumaki K, Sakabe M, Sugao M, Tsuneda T, Inoue H (2004) Canine model of Brugada syndrome using regional epicardial cooling of the right ventricular outflow tract. J Cardiovasc Electrophysiol 15:936–941

    Article  PubMed  Google Scholar 

  26. Tsuji H, Larson MG, Venditti FJ Jr, Manders ES, Evans JC, Feldman CL, Levy D (1996) Impact of reduced heart rate variability on risk for cardiac events. The Framingham Heart Study. Circulation 94:2850–2855

    Article  CAS  PubMed  Google Scholar 

  27. Pierre B, Babuty D, Poret P, Giraudeau C, Marie O, Cosnay P, Fauchier L (2007) Abnormal nocturnal heart rate variability and QT dynamics in patients with Brugada syndrome. Pacing Clin Electrophysiol 30 Suppl 1:S188–S191

    PubMed  Google Scholar 

  28. Ikeda T, Abe A, Yusu S, Nakamura K, Ishiguro H, Mera H, Yotsukura M, Yoshino H (2006) The full stomach test as a novel diagnostic technique for identifying patients at risk of Brugada syndrome. J Cardiovasc Electrophysiol 17:602–607

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

    Authors and Affiliations

    1. Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan

      Shogo Sakamoto, Masahiko Takagi, Jun Kakihara, Yusuke Hayashi, Atsushi Doi, Kenichi Sugioka & Minoru Yoshiyama

    Authors
    1. Shogo Sakamoto
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Masahiko Takagi
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Jun Kakihara
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Yusuke Hayashi
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Atsushi Doi
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Kenichi Sugioka
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Minoru Yoshiyama
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Masahiko Takagi.

    Ethics declarations

    Conflict of interest

    The authors declare that they have no conflicts of interest.

    Additional information

    S. Sakamoto and M. Takagi equally contributed to this manuscript.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Sakamoto, S., Takagi, M., Kakihara, J. et al. The utility of T-wave alternans during the morning in the summer for the risk stratification of patients with Brugada syndrome. Heart Vessels 32, 341–351 (2017). https://doi.org/10.1007/s00380-016-0882-2

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00380-016-0882-2

    Keywords

    Search

    Navigation