Brugada syndrome behind complete right bundle-branch block

Yoshiyasu Aizawa, Seiji Takatsuki, Motoaki Sano, Takehiro Kimura, Nobuhiro Nishiyama, Kotaro Fukumoto, Yoko Tanimoto, Kojiro Tanimoto, Mitsushige Murata, Takashi Komatsu, Hideo Mitamura, Satoshi Ogawa, Toshikazu Funazaki, Masahito Sato, Yoshifusa Aizawa, Keiichi Fukuda

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

BACKGROUND-: The characteristic ECG of Brugada syndrome (BS) can be masked by complete right bundle-branch block (CRBBB) and exposed by resolution of the block or pharmacological or pacing maneuvers. METHODS AND RESULTS-: The study consisted of 11 patients who had BS and CRBBB. BS was diagnosed before the development of CRBBB, on the resolution of CRBBB, or from new characteristic ST-segment changes that could be attributable to BS. Structural heart diseases were excluded, and coronary spasm was excluded on the basis of a provocation test at catheterization. In 7 patients, BS was diagnosed before the development of CRBBB. BS was diagnosed when CRBBB resolved spontaneously (n=1) or by right ventricular pacing (n=3). The precipitating cause for the spontaneous resolution of CRBBB, however, was not apparent. On repeated ECGs, new additional upward-convex ST-segment elevation was found in V2 or V3 in 3 patients. In 2 patients, new ST-segment elevation was induced by class IC drugs. The QRS duration was more prolonged in patients with BS and CRBBB compared with age-and sex-matched controls: 170±13 versus 145±15 milliseconds in V1 and 144±19 versus 128±7 milliseconds in V5 (both P<0.0001). The amplitude of R in V1 was larger in the BS patients than in the control subjects (P=0.0323), but that of R′ was similar (P=0.0560). CONCLUSIONS-: BS can coexist behind CRBBB, and CRBBB can completely mask BS. BS might be demonstrated by relief of CRBBB or by spontaneous or drug-induced ST-segment elevation. The prevalence, mechanism, and clinical significance of a combination of CRBBB and BS are yet to be determined.

Original languageEnglish
Pages (from-to)1048-1054
Number of pages7
JournalCirculation
Volume128
Issue number10
DOIs
Publication statusPublished - 2013 Sep 3

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Brugada Syndrome
Bundle-Branch Block
Electrocardiography
Spasm
Masks
Catheterization
Pharmaceutical Preparations
Heart Diseases

Keywords

  • Brugada syndrome
  • bundle-branch block
  • cardiac pacing, artificial
  • sodium channels

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Brugada syndrome behind complete right bundle-branch block. / Aizawa, Yoshiyasu; Takatsuki, Seiji; Sano, Motoaki; Kimura, Takehiro; Nishiyama, Nobuhiro; Fukumoto, Kotaro; Tanimoto, Yoko; Tanimoto, Kojiro; Murata, Mitsushige; Komatsu, Takashi; Mitamura, Hideo; Ogawa, Satoshi; Funazaki, Toshikazu; Sato, Masahito; Aizawa, Yoshifusa; Fukuda, Keiichi.

In: Circulation, Vol. 128, No. 10, 03.09.2013, p. 1048-1054.

Research output: Contribution to journalArticle

Aizawa, Y, Takatsuki, S, Sano, M, Kimura, T, Nishiyama, N, Fukumoto, K, Tanimoto, Y, Tanimoto, K, Murata, M, Komatsu, T, Mitamura, H, Ogawa, S, Funazaki, T, Sato, M, Aizawa, Y & Fukuda, K 2013, 'Brugada syndrome behind complete right bundle-branch block', Circulation, vol. 128, no. 10, pp. 1048-1054. https://doi.org/10.1161/CIRCULATIONAHA.113.003472
Aizawa, Yoshiyasu ; Takatsuki, Seiji ; Sano, Motoaki ; Kimura, Takehiro ; Nishiyama, Nobuhiro ; Fukumoto, Kotaro ; Tanimoto, Yoko ; Tanimoto, Kojiro ; Murata, Mitsushige ; Komatsu, Takashi ; Mitamura, Hideo ; Ogawa, Satoshi ; Funazaki, Toshikazu ; Sato, Masahito ; Aizawa, Yoshifusa ; Fukuda, Keiichi. / Brugada syndrome behind complete right bundle-branch block. In: Circulation. 2013 ; Vol. 128, No. 10. pp. 1048-1054.
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AU - Aizawa, Yoshiyasu

AU - Takatsuki, Seiji

AU - Sano, Motoaki

AU - Kimura, Takehiro

AU - Nishiyama, Nobuhiro

AU - Fukumoto, Kotaro

AU - Tanimoto, Yoko

AU - Tanimoto, Kojiro

AU - Murata, Mitsushige

AU - Komatsu, Takashi

AU - Mitamura, Hideo

AU - Ogawa, Satoshi

AU - Funazaki, Toshikazu

AU - Sato, Masahito

AU - Aizawa, Yoshifusa

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N2 - BACKGROUND-: The characteristic ECG of Brugada syndrome (BS) can be masked by complete right bundle-branch block (CRBBB) and exposed by resolution of the block or pharmacological or pacing maneuvers. METHODS AND RESULTS-: The study consisted of 11 patients who had BS and CRBBB. BS was diagnosed before the development of CRBBB, on the resolution of CRBBB, or from new characteristic ST-segment changes that could be attributable to BS. Structural heart diseases were excluded, and coronary spasm was excluded on the basis of a provocation test at catheterization. In 7 patients, BS was diagnosed before the development of CRBBB. BS was diagnosed when CRBBB resolved spontaneously (n=1) or by right ventricular pacing (n=3). The precipitating cause for the spontaneous resolution of CRBBB, however, was not apparent. On repeated ECGs, new additional upward-convex ST-segment elevation was found in V2 or V3 in 3 patients. In 2 patients, new ST-segment elevation was induced by class IC drugs. The QRS duration was more prolonged in patients with BS and CRBBB compared with age-and sex-matched controls: 170±13 versus 145±15 milliseconds in V1 and 144±19 versus 128±7 milliseconds in V5 (both P<0.0001). The amplitude of R in V1 was larger in the BS patients than in the control subjects (P=0.0323), but that of R′ was similar (P=0.0560). CONCLUSIONS-: BS can coexist behind CRBBB, and CRBBB can completely mask BS. BS might be demonstrated by relief of CRBBB or by spontaneous or drug-induced ST-segment elevation. The prevalence, mechanism, and clinical significance of a combination of CRBBB and BS are yet to be determined.

AB - BACKGROUND-: The characteristic ECG of Brugada syndrome (BS) can be masked by complete right bundle-branch block (CRBBB) and exposed by resolution of the block or pharmacological or pacing maneuvers. METHODS AND RESULTS-: The study consisted of 11 patients who had BS and CRBBB. BS was diagnosed before the development of CRBBB, on the resolution of CRBBB, or from new characteristic ST-segment changes that could be attributable to BS. Structural heart diseases were excluded, and coronary spasm was excluded on the basis of a provocation test at catheterization. In 7 patients, BS was diagnosed before the development of CRBBB. BS was diagnosed when CRBBB resolved spontaneously (n=1) or by right ventricular pacing (n=3). The precipitating cause for the spontaneous resolution of CRBBB, however, was not apparent. On repeated ECGs, new additional upward-convex ST-segment elevation was found in V2 or V3 in 3 patients. In 2 patients, new ST-segment elevation was induced by class IC drugs. The QRS duration was more prolonged in patients with BS and CRBBB compared with age-and sex-matched controls: 170±13 versus 145±15 milliseconds in V1 and 144±19 versus 128±7 milliseconds in V5 (both P<0.0001). The amplitude of R in V1 was larger in the BS patients than in the control subjects (P=0.0323), but that of R′ was similar (P=0.0560). CONCLUSIONS-: BS can coexist behind CRBBB, and CRBBB can completely mask BS. BS might be demonstrated by relief of CRBBB or by spontaneous or drug-induced ST-segment elevation. The prevalence, mechanism, and clinical significance of a combination of CRBBB and BS are yet to be determined.

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