新胸导联在诊断Brugada综合征中的应用

A novel precordial leads system for detection of Brugada syndrome

目的 评价自行设计的新胸导联在Brugada综合征诊断中的应用价值。方法 4例Brugada综合征先证者和9例家族成员接受新胸导联和普罗帕酮药物试验。11例无晕厥史和无猝死家族史的房室结折返性室上性心动过速患者作为新胸导联检查对照组。自行设计的心电图新胸导联包括A-G(7)列、0-5(6)行,共42个导联,记录方法同标准胸导联。普罗帕酮试验:普罗帕酮70 mg(体重>70kg者用105 mg)加入生理盐水10 ml于5 min内静脉注射,用药前、后记录标准12导联心电图;用药后标准V1-V3导联J点或ST段抬高超过2 mm(或ST段抬高由BrugadaⅡ或Ⅲ型转变成Ⅰ型),称为药物试验阳性。结果 先证者1～3均有晕厥史,先证者1和3有家族猝死史,先证者2和3晕厥发作时记录到心室颤动,先证者3猝死;除先证者4标准胸导联心电图呈Brugada典型下斜型改变外,先证者1-3标准胸导联心电图不能明确诊断为Brugada综合征。新胸导联发现先证者1-3呈典型Brugada综合征心电图改变,位于标准胸导联以外区域。新胸导联同时发现,5例家族成员在标准胸导联以外区域有典型的Brugada心电图改变。新胸导联阳性者亦被普罗帕酮试验证实。对照组11例新胸导联检查均为阴性。结论 新胸导联有助于发现Brugada综合征典型心电图改变位于标准V1-V3导联以外的病例,且应用安全。

Objective To evaluate the value of novel precordial lead system for detection of Brugada syndrome. Methods Four probands with Brugada syndrome and nine of their familial members underwent the novel precodial lead system work-up and propafenone challenge. The control group included 11 patients with atrioventricular node reentry but without syncope and family history for sudden death. The novel precordial leads system constituted 42 leads ( A - G column ,0-5 row) , the method for novel precordial leads recording was as same as the standard precordial lead. Propafenone challenge; 70 mg propafenone (weight > 70 kg, 105 mg)in 0.9% NaCl 10 ml was given intravenously in 5 minutes, the standard 12 lead electrocardiograghic was recorded before and after the drug adminstration. It was referred to as drug challenge positive that J point amplitude or ST segment elevation in standard precordial V1-V3 lead after propafenone administration was more than 2 mm ( or conversion Brugada type Ⅱ or Ⅲ to type Ⅰ). Results The proband 1-3 had history of syncope. The proband 1 and 3 had the family history for sudden death. The ventricular fibrillation was documented by EGG in proband 2 and 3. The proband 3 got a sudden death. Expect proband 4, their standard 12 lead ECG were not enough for making Brugada syndrome diagnosis in proband 1-3. The typical Brugada ST segment elevation was found in proband 1-3 by the novel precordial leads system, which located in the area out of the standard precordial leads. The same findings also observed in 5 familial members by the novel system. The positives ( with typical Brugada ST segment elevation in the novel precordial lead system were also confirmed by the propafenone challenge. All the 11 patients in controlled group were normal in the novel precordial leads system work-up. Conclusions The novel precordial lead system was helpful for detecting Brugada syndrome which typical ST elevation was out of the standard precordial V1- V3 leads. The novel system was also safety and simple for recording. The propafenone challenge also raised the sensitivity of the Brugada syndrome diagnosis.