The Utility of Sodium Channel Provocation in Unexplained Cardiac Arrest Survivors and Electrocardiographic Predictors of Ventricular Fibrillation Recurrence
- Resource Type
- Authors
- Bode Ensam; Christopher C. Cheung; Fahad Almehmadi; Bo Gregers Winkel; Chiara Scrocco; Paul Brennan; Kevin Leong; Alison Muir; Amanda Vanarva; Jacob Tfelt-Hansen; Jason D. Roberts; Andrew D. Krahn; Elijah R. Behr
- Source
- Ensam, B, Cheung, C C, Almehmadi, F, Gregers Winkel, B, Scrocco, C, Brennan, P, Leong, K, Muir, A, Vanarva, A, Tfelt-Hansen, J, Roberts, J D, Krahn, A D & Behr, E R 2022, ' The Utility of Sodium Channel Provocation in Unexplained Cardiac Arrest Survivors and Electrocardiographic Predictors of Ventricular Fibrillation Recurrence ', Circulation. Arrhythmia and electrophysiology, vol. 15, no. 12, e011263, pp. 823-835 . https://doi.org/10.1161/CIRCEP.122.011263
- Subject
- Physiology (medical)
Cardiology and Cardiovascular Medicine
- Language
- English
Background: The implications of a drug-induced type 1 Brugada ECG pattern following sodium channel blocker provocation (SCBP) are not fully understood. Methods: Baseline clinical and ECG data were obtained from consecutive unexplained cardiac arrest survivors undergoing SCBP at 3 centers. A further 15 SCBP positive (SCBP+) unexplained cardiac arrest survivors were recruited from 3 additional centers to explore ventricular fibrillation recurrence. Results: A total of 121 consecutive unexplained cardiac arrest survivors underwent SCBP. The yield of the drug-induced type 1 Brugada ECG pattern was 17%. A baseline type 2/3 Brugada pattern (T2/3BP) (adjusted odds ratio, 19.36 [2.74–136.61]; P =0.003) and PR interval (odds ratio, 1.03 [1.01–1.05] per ms; P =0.017) were independent predictors of SCBP+ response. A pathogenic SCN5A variant was identified in 36% of the SCBP+ group versus 0% in the SCBP− group ( P P =0.011) and the presence of global early repolarization (hazard ratio, 7.91 [3.22–19.44]; P P =0.055). Conclusions: The yield of the drug-induced type 1 Brugada ECG pattern in consecutive unexplained cardiac arrest survivors undergoing SCBP is 17%. A baseline T2/3BP and PR interval were independent predictors of the drug-induced type 1 Brugada ECG pattern. Greater heritability of BrS phenotype in this group was evidenced by a greater prevalence of pathogenic SCN5A variants and relatives with a type 1 Brugada pattern. A history of prior syncope and the presence of global early repolarization were independent predictors of ventricular fibrillation recurrence.