Amin et al. 88. Amin AS, de Groot EA, Ruijter JM, Wilde AA, Tan HL. Exercise-induced ECG changes in Brugada syndrome. Circ Arrhythm Electrophysiol. 2009;2(5):531-9. doi: 10.1161/CIRCEP.109.86241. https://doi.org/10.1161/CIRCEP.109.86241...
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Retrospective |
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35
-
Controls
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25 BS*
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SCN5A+
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25 SB
-
SCN5A-
|
Male |
-
SCN5A+: 43+/-3
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SCN5A-: 42+/-2
|
-
SCN5A+:
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VF†/VT‡ (1)
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syncope (6)
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palpitations (2)
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SCN5A-:
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VF/VT (1)
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syncope (6)
-
palpitations (4)
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Exercise accentuated the type 1 Brugada electrocardiographic phenotype in the BS group. Peak J-point amplitude was found in early recovery, with no significant difference (p=0.093). The presence of an SCN5A mutation was associated with higher conduction slowing at fast heart rates (p<0.001) |
Chanavirut et al. 99. Chanavirut R, Makarawate P, Macdonald IA, Leelayuwat N. Autonomic and cardio-respiratory responses to exercise in Brugada syndrome patients. J Arrhyth. 2016;32:426-32. doi: 10.1016/j.joa.2015.09.001. |
Cross-sectional |
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23
-
Controls
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11 BS com
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ICD#
|
Male |
50+/-6 |
SCD survivors**
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All patient performed an exercise test on a cycle ergometer, Patients with BS showed higher parasympathetic and lower sympathetic activation during the recovery period (p<0.05) |
Makimoto et al. 1010. Makimoto H, Nakagawa E, Takaki H, Yamada Y, Okamura H, Noda T, et al. Augmented ST-segment elevation during recovery from exercise predicts cardiac events in patients with Brugada syndrome. J Am Coll Cardiol. 2010;56(19):1576-84. doi: 10.1016/j.jacc.2010.06.033. |
Prospective |
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91 Men |
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Controls: 46+/-17
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SB: 46+/-14
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Elevation of ST-segment > 0.05mV in V1-V3 during early recovery from exercise testing in 34 patients with BS, During 76 ± 38 months of follow-up, VF occurred in 44% of patients with BS and ST elevation vs. 17% in BS without ST elevation (p=0.004) |
Morita et al. 1111. Morita H, Asada ST, Miyamoto M, Morimoto Y, Kimura T, Mizuno T, et al. Significance of Exercise-Related Ventricular Arrhythmias in Patients With Brugada Syndrome. J Am Heart Assoc. 2020;9(23):e016907. doi: 10.1161/JAHA.120.016907. |
Prospective |
307 SB |
299 Men |
45+/-12 |
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Syncope (75)
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Aborted SCD (13)
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Ventricular extrasystoles occurred in 27% of patients at the time of treadmill exercise test. During 92+/-68 months of follow-up, 30 patients experienced VF; VF was more frequent in those who experienced ventricular extrasystoles early after exercise (1.5-3 minutes) (p<0.05). Multivariate analysis including symptoms, spontaneous type 1 ECG, and ventricular extrasystoles in the early recovery phase showed that these factors were independently associated with VF (p<0.05) |
Pospiech et al. 1212. Pospiech T, Jaussaud J, Sacher F, Hooks DA, Haïssaguerre M, Douard H. Characterization of repolarization in Brugada syndrome patients during exercise testing: Dynamic angle evaluation. J Electrocardiol. 2015;48(5):879-86. DOI: 10.1016/j.jelectrocard.2015.06.008. |
Prospective |
|
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IRBBB‡‡: 13 Men
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BS: 40 Men
|
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IRBBB: 43+/-13
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BS: 49+/-14
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Syncope (9)
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Dizziness (4)
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Chest pain (3)
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Palpitations (2)
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BS patients showed larger beta angle at rest, exercise and recovery compared to IRBBB patients (p<0.001). Assessment of beta angle at exercise could help discriminate BS patients from healthy individuals |
Subramanian et al. 1313. Subramanian M, Prabhu MA, Harikrishnan MS, Shekhar SS, Pai PG, Natarajan K. The Utility of Exercise Testing in Risk Stratification of Asymptomatic Patients With Type 1 Brugada Pattern. J Cardiovasc Electrophysiol. 2017;28(6):677-83. DOI: 10.1111/jce.13205. |
Prospective |
|
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Controls: 75 Men
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SBS 68 Men
|
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Controls: 48,5+/-13,7
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SB: 49,1 +/-15,4
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Asymptomatic |
Patients performed exercise testing and were followed up for 77.9+/-28.9 months. Multivariate analysis revealed that increase in S wave upslope duration ratio >30% at peak exercise (HR 1.35, 95% CI 1.08-10.97, P = 0.023), augmentation of J point elevation in lead aVR >2 mm in late recovery (HR 1.88, 95% 1.21-15.67, P = 0.011), and delayed HR recovery (HR 1.14, 95% CI 1.06-18.22, P = 0.042) were correlated with worse outcomes |
Tachibana et al. 1414. Tachibana M, Nishii N, Morita H, Nakagawa K, Watanabe A, Nakamura K, et al. Exercise stress test reveals ineligibility for subcutaneous implantable cardioverter defibrillator in patients with Brugada syndrome. J Cardiovasc Electrophysiol. 2017;28(12):1454-9. doi: 10.1111/jce.13315. |
Cross-sectional |
110 |
108 Men |
54+/-13 |
-
VF/aborted SCD (13)
-
Syncope (39)
|
BS patients who were assessed for subcutaneous ICD eligibility were studied. Forty-five patients were considered eligible for ICD implantation using ECG. The presence of complete right bundle branch block was a significant predictor of ineligibility for S-ICD (p=0.03). After exercise stress testing, 11 patients showed ineligibility for S-ICD. ECG during exercise showed higher T-wave voltage and lower R-wave voltage/T-wave voltage ratio (p<0.01). Therefore, exercise stress testing should be considered before subcutaneous ICD implantation. |
Von Hafe et al. 1515. von Hafe P, Faria B, Dias G, Cardoso F, Alves MJ, Alves A, et al. Brugada syndrome: Eligibility for subcutaneous implantable cardioverter-defibrillator after exercise stress test. Rev Port Cardiol. 2021;40(1):33-8. doi: 10.1016/j.repc.2020.05.013. |
Cross-sectional |
35 |
25 Male |
53.8+/-12 |
Syncope (10) |
Patients with BS who were assessed for subcutaneous ICD eligibility were studied. Of these, 14.3% were considered ineligible for ICD implantation using ECG at rest. The presence of complete right bundle branch block was associated with subcutaneous ICD ineligibility (p<0.01) After exercise stress testing, the percentage of ineligible patients increased to 16.7%, with no significant difference in ECG variables between eligible and ineligible patients. The study indicates the importance of screening after exercise stress testing in all patients with BS and indication for subcutaneous ICD |