ST-segment elevation and ventricular fibrillation without coronary spasm by intracoronary injection of acetylcholine and/or ergonovine maleate in patients with Brugada syndrome.

Abstract

OBJECTIVES:

The study examined whether patients with Brugada syndrome are sensitive to vagal stimulation or ischemia.

BACKGROUND:

Experimental studies have suggested that a prominent transient outward current (I(to))-mediated action potential notch and a subsequent loss of the action potential dome in the epicardium, but not in the endocardium, give rise to ST-segment elevation and subsequent ventricular fibrillation (VF).

METHODS:

We evaluated the frequency of coronary spasm, augmentation (> or =0.1 mV) of ST-segment elevation in leads V(1) to V(3), and induction of VF by intracoronary injection of acetylcholine (ACh) and/or ergonovine maleate (EM) in 27 symptomatic patients with Brugada syndrome and 30 control subjects.

RESULTS:

The coronary spasm was induced in 3 (11%) of the 27 patients with Brugada syndrome and in 13 (43%) of the 30 control subjects. ST-segment elevation was augmented by 11 (33%) of the 33 right coronary injections (ACh: 6/11 [55%]; EM: 5/22 [23%]), without coronary spasm, but not by any of the left coronary injections in patients with Brugada syndrome. Ventricular fibrillation was induced by 3 (9%) of the 33 right coronary injections (ACh: 2/11 [18%]; EM: 1/22 [5%]), but not by any of the left coronary injections. In contrast, neither ST-segment elevation nor VF was observed in any of the control subjects.

CONCLUSIONS:

Our results support the hypothesis that mild ischemia and vagal influences act additively or synergistically with the substrate responsible for the Brugada syndrome to elevate the ST-segment and precipitate VF. These observations suggest that Brugada patients may be at a higher risk for ischemia-related sudden death.

• Authors: Takashi Noda, Wataru Shimizu, Atsushi Taguchi, Kazuhiro Satomi, Kazuhiro Suyama, Takashi Kurita, Naohiko Aihara, Shiro Kamakura
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 40 Issue 10 Pg. 1841-7 (Nov 20 2002) ISSN: 0735-1097 [Print] United States
• PMID: 12446069 (Publication Type: Comparative Study, Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Vasodilator Agents
• Acetylcholine
• Ergonovine

Topics

• Acetylcholine (administration & dosage)
• Adult
• Aged
• Bundle-Branch Block (complications)
• Coronary Vasospasm (chemically induced)
• Coronary Vessels
• Death, Sudden, Cardiac (etiology)
• Dose-Response Relationship, Drug
• Electrocardiography
• Ergonovine (administration & dosage)
• Female
• Heart Conduction System (drug effects)
• Humans
• Injections, Intravenous
• Japan
• Male
• Middle Aged
• Syndrome
• Vasodilator Agents (administration & dosage)
• Ventricular Fibrillation (chemically induced)