应用普罗帕酮激发试验对Brugada综合征七例患者的诊断价值

The diagnostic value of propafenone challenge testing in seven patients with Brugada syndrome

目的 评价应用普罗帕酮激发试验诊断Brugada综合征 (BS)的有效性和特异性。方法7例怀疑BS者和 10例对照者 ,经体格检查、X线胸片和超声心动图初步排除器质性心脏病 ,BS组行冠状动脉以及左、右心室造影排除冠心病。做好电复律和心肺复苏准备后按分级推注方案行普罗帕酮激发试验 ,观察标准 12导联心电图并监护心律失常发作。结果 7例疑似BS者均达到欧洲心脏病学会建议诊断标准。 3例晕厥患者被确诊为BS ,另 4例被诊断为BS样心电图改变。 3例晕厥患者中 2例植入ICD ,其中 1例随访 10个月有 14次夜间心室颤动发作。另 1例拒绝植入ICD ,随访 4个月后夜间猝死。另 5例随访 (8± 6 )个月无心律失常事件发生。除 1例试验中出现室性早搏、心室颤动外 ,余无不良反应出现。结论 普罗帕酮激发试验可有效、特异地用于诊断Brugada综合征。

Objective To evaluate the effectiveness and specificity of propafenone challenge testing in the diagnosis of Brugada syndrome(BS).Methods Seven consecutive patients who were suspected of BS and 10 control cases were included in this study.Physical examination,chest X-ray,and echocardiogram excluded structural heart disease in all patients.The BS patients also underwent coronary angiography and ventriculography.After defibrillator and cardio-pulmonary resuscitation was available,propafenone challenge test was performed,and standard 12 leads electrocardiogram was monitored continuously and recorded every 5 minutes.Results The propafenone administration resulted in J point and/or ST-segment elevation in all consecutive patients,which reach the diagnostic criteria in ESC Consensus Report,and indication could not be observed in 10 cases in the control group.Three patients with positive propafenone challenge results and the symptom of syncope,standard 12-lead ECG were diagnosed as BS,the rest 4 cases was referred to as idiopathic BS ECG pattern.Two BS patients received ICD implantation,one of them had 14 episodes of nocturnal ventricular fibrillation during follow-up of 10 months.The third BS patient with syncope who refused ICD implantation died suddenly at night 4 months after the diagnosis.No arrhythmia event occurred in other 5 cases during a follow-up of a mean(8±6) months revealed.There was no other side effect except one patient developed spontaneous ventricular fibrillation 7 minutes after intravenous administration of the propafenone.Conclusion The data suggested that propafenone challenge testing was effective and specific in the diagnosis of concealed Brugada syndrome.