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Restitution metrics in Brugada syndrome: a systematic review and meta-analysis

Authors
  • Tse, Gary1, 2
  • Lee, Sharen3
  • Gong, Mengqi2
  • Mililis, Panagiotis4
  • Asvestas, Dimitrios4
  • Bazoukis, George4
  • Roever, Leonardo5
  • Jeevaratnam, Kamalan6
  • Hothi, Sandeep S.7
  • Li, Ka Hou Christien1, 2, 8
  • Liu, Tong2
  • Letsas, Konstantinos P.4
  • 1 Xiamen Cardiovascular Hospital Affiliated to Xiamen University, Xiamen, Fujian, People’s Republic of China , Xiamen (China)
  • 2 Second Hospital of Tianjin Medical University, Tianjin, 300211, People’s Republic of China , Tianjin (China)
  • 3 Li Ka Shing Institute of Health Sciences, Hong Kong, SAR, People’s Republic of China , Hong Kong (China)
  • 4 Evangelismos General Hospital of Athens, Athens, Greece , Athens (Greece)
  • 5 Federal University of Uberlândia, Uberlândia, MG, Brazil , Uberlândia (Brazil)
  • 6 University of Surrey, Guildford, UK , Guildford (United Kingdom)
  • 7 New Cross Hospital, Wolverhampton, UK , Wolverhampton (United Kingdom)
  • 8 Newcastle University, Newcastle, UK , Newcastle (United Kingdom)
Type
Published Article
Journal
Journal of Interventional Cardiac Electrophysiology
Publisher
Springer-Verlag
Publication Date
Dec 14, 2019
Volume
57
Issue
2
Pages
319–327
Identifiers
DOI: 10.1007/s10840-019-00675-z
Source
Springer Nature
Keywords
License
Yellow

Abstract

BackgroundBrugada syndrome (BrS) is an ion channelopathy that predisposes affected subjects to ventricular tachycardia/fibrillation (VT/VF) and sudden cardiac death. Restitution analysis has been examined in BrS patients but not all studies have reported significant differences between BrS patients and controls. Therefore, we conducted a systematic review and meta-analysis to investigate the different restitution indices used in BrS.MethodsPubMed and Embase were searched until April 7, 2019, identifying 20 and 27 studies.ResultsA total of ten studies involving 178 BrS (mean age 38 years old, 63% male) and 102 controls (mean age 31 years old, 42% male) were included in this systematic review. Pacing was carried out at the right ventricular outflow tract (RVOT)/right ventricular apex (RPA) (n = 4), RPA (n = 4), or right atrium (RA) (n = 1). Basic cycle lengths of 400 (n = 4), 500 (n = 2), 600 (n = 6) and 750 ms (n = 1) were used. Recording methods include electrograms (n = 4), monophasic action potentials (n = 5), and electrocardiograms (n = 1). Signals were obtained from the RVOT (n = 8), RVA (n = 3), RA (n = 1), or the body surface (n = 1). The maximum restitution slope for endocardial repolarization at the RVOT was 0.87 for BrS patients (n = 5; 95% confidence interval [CI] 0.68–1.07) compared with 0.74 in control subjects (n = 4; 95% CI 0.42–1.06), with a significant mean difference of 0.40 (n = 4; 95% CI 0.11–0.69; P = 0.007).ConclusionsSteeper endocardial repolarization restitution slopes are found in BrS patients compared with controls at baseline. Restitution analysis can provide important information for risk stratification in BrS.

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