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Clinical Characteristics and Electrophysiological Mechanisms Underlying Brugada ECG in Patients With Severe Hyperkalemia

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Clinical Characteristics and Electrophysiological Mechanisms Underlying Brugada ECG in Patients With Severe Hyperkalemia

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dc.contributor.author Rivera-Juárez, Allan es_ES
dc.contributor.author Hernández-Romero, Ismael es_ES
dc.contributor.author Puertas, Carolina es_ES
dc.contributor.author Zhang-Wang, Serena es_ES
dc.contributor.author Sánchez-Álamo, Beatriz es_ES
dc.contributor.author Martins, Raphael es_ES
dc.contributor.author Figuera, Carlos es_ES
dc.contributor.author Guillem Sánchez, María Salud es_ES
dc.contributor.author Martínez Climent, Batiste Andreu es_ES
dc.contributor.author Fernández-Avilés, Francisco es_ES
dc.contributor.author Tejedor, Alberto es_ES
dc.contributor.author Jalife, José es_ES
dc.contributor.author Atienza, Felipe es_ES
dc.date.accessioned 2021-02-03T04:33:31Z
dc.date.available 2021-02-03T04:33:31Z
dc.date.issued 2019-02-05 es_ES
dc.identifier.uri http://hdl.handle.net/10251/160595
dc.description.abstract [EN] Background-Several metabolic conditions can cause the Brugada ECG pattern, also called Brugada phenotype (BrPh). We aimed to define the clinical characteristics and outcome of BrPh patients and elucidate the mechanisms underlying BrPh attributed to hyperkalemia. Methods and Results-We prospectively identified patients hospitalized with severe hyperkalemia and ECG diagnosis of BrPh and compared their clinical characteristics and outcome with patients with hyperkalemia but no BrPh ECG. Computer simulations investigated the roles of extracellular potassium increase, fibrosis at the right ventricular outflow tract, and epicardial/endocardial gradients in transient outward current. Over a 6-year period, 15 patients presented severe hyperkalemia with BrPh ECG that was transient and disappeared after normalization of their serum potassium. Most patients were admitted because of various severe medical conditions causing hyperkalemia. Six (40%) patients presented malignant arrhythmias and 6 died during admission. Multiple logistic regression analysis revealed that higher serum potassium levels (odds ratio, 15.8; 95% CI, 3.1-79; P=0.001) and male sex (odds ratio, 17; 95% CI, 1.05-286; P=0.045) were risk factors for developing BrPh ECG in patients with severe hyperkalemia. In simulations, hyperkalemia yielded BrPh by promoting delayed and heterogeneous right ventricular outflow tract activation attributed to elevation of resting potential, reduced availability of inward sodium channel conductance, and increased right ventricular outflow tract fibrosis. An elevated transient outward current gradient contributed to, but was not essential for, the BrPh phenotype. Conclusions-In patients with severe hyperkalemia, a BrPh ECG is associated with malignant arrhythmias and all-cause mortality secondary to resting potential depolarization, reduced sodium current availability, and fibrosis at the right ventricular outflow tract. es_ES
dc.description.sponsorship This work was funded in part by the CIBERCV (Centro de Investigacion Biomedica en Red Enfermedades Cardiovasculares), Instituto de Salud Carlos III (PI14/00857, DTS16/0160, PI17/1059, PI01106), Spanish Ministry of Ecomomy (TEC2013-46067-R) and the ERDF (European Regional Development Fund). es_ES
dc.language Inglés es_ES
dc.publisher John Wiley & Sons es_ES
dc.relation.ispartof Journal of the American Heart Association es_ES
dc.rights Reconocimiento - No comercial (by-nc) es_ES
dc.subject Brugada syndrome es_ES
dc.subject Hyperkalemia es_ES
dc.subject Sudden cardiac death es_ES
dc.subject.classification TECNOLOGIA ELECTRONICA es_ES
dc.title Clinical Characteristics and Electrophysiological Mechanisms Underlying Brugada ECG in Patients With Severe Hyperkalemia es_ES
dc.type Artículo es_ES
dc.identifier.doi 10.1161/JAHA.118.010115 es_ES
dc.relation.projectID info:eu-repo/grantAgreement/MINECO//PI14%2F00857/ES/Caracterización No-invasiva de los Mecanismos de Mantenimiento de la Fibrilación Auricular. Estudio PERSONALIZE-AF/ es_ES
dc.relation.projectID info:eu-repo/grantAgreement/MINECO//TEC2013-46067-R/ES/ESTIMACION NO INVASIVA DE LA ACTIVIDAD ELECTRICA CARDIACA MEDIANTE OPTIMIZACION CONVEXA/ es_ES
dc.relation.projectID info:eu-repo/grantAgreement/ISCIII//PI17%2F01059/ES/Estratificación y tratamiento de la fibrilación auricular basada en los mecanismos de perpetuación de la arritmia/STRATIFY-AF/ es_ES
dc.relation.projectID info:eu-repo/grantAgreement/ISCIII//DTS16%2F0160/ es_ES
dc.relation.projectID info:eu-repo/grantAgreement/ISCIII//PI17%2F01106/ES/Estratificación y tratamiento de la fibrilación auricular basada en los mecanismos de perpetuación de la arritmia/ es_ES
dc.rights.accessRights Abierto es_ES
dc.contributor.affiliation Universitat Politècnica de València. Instituto Universitario de Telecomunicación y Aplicaciones Multimedia - Institut Universitari de Telecomunicacions i Aplicacions Multimèdia es_ES
dc.contributor.affiliation Universitat Politècnica de València. Departamento de Ingeniería Electrónica - Departament d'Enginyeria Electrònica es_ES
dc.description.bibliographicCitation Rivera-Juárez, A.; Hernández-Romero, I.; Puertas, C.; Zhang-Wang, S.; Sánchez-Álamo, B.; Martins, R.; Figuera, C.... (2019). Clinical Characteristics and Electrophysiological Mechanisms Underlying Brugada ECG in Patients With Severe Hyperkalemia. Journal of the American Heart Association. 8(3):1-15. https://doi.org/10.1161/JAHA.118.010115 es_ES
dc.description.accrualMethod S es_ES
dc.relation.publisherversion https://doi.org/10.1161/JAHA.118.010115 es_ES
dc.description.upvformatpinicio 1 es_ES
dc.description.upvformatpfin 15 es_ES
dc.type.version info:eu-repo/semantics/publishedVersion es_ES
dc.description.volume 8 es_ES
dc.description.issue 3 es_ES
dc.identifier.eissn 2047-9980 es_ES
dc.identifier.pmid 30675825 es_ES
dc.identifier.pmcid PMC6405573 es_ES
dc.relation.pasarela S\410215 es_ES
dc.contributor.funder European Regional Development Fund es_ES
dc.contributor.funder Ministerio de Economía y Competitividad es_ES
dc.contributor.funder Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares es_ES
dc.description.references Brugada, P., & Brugada, J. (1992). Right bundle branch block, persistent ST segment elevation and sudden cardiac death: A distinct clinical and electrocardiographic syndrome. Journal of the American College of Cardiology, 20(6), 1391-1396. doi:10.1016/0735-1097(92)90253-j es_ES
dc.description.references Antzelevitch, C., Brugada, P., Borggrefe, M., Brugada, J., Brugada, R., Corrado, D., … Wilde, A. (2005). Brugada Syndrome: Report of the Second Consensus Conference. Circulation, 111(5), 659-670. doi:10.1161/01.cir.0000152479.54298.51 es_ES
dc.description.references Priori, S. G., Wilde, A. A., Horie, M., Cho, Y., Behr, E. R., Berul, C., … Tracy, C. (2013). HRS/EHRA/APHRS Expert Consensus Statement on the Diagnosis and Management of Patients with Inherited Primary Arrhythmia Syndromes. Heart Rhythm, 10(12), 1932-1963. doi:10.1016/j.hrthm.2013.05.014 es_ES
dc.description.references Bezzina, C. R., Barc, J., Mizusawa, Y., Remme, C. A., Gourraud, J.-B., Simonet, F., … Dagradi, F. (2013). Common variants at SCN5A-SCN10A and HEY2 are associated with Brugada syndrome, a rare disease with high risk of sudden cardiac death. Nature Genetics, 45(9), 1044-1049. doi:10.1038/ng.2712 es_ES
dc.description.references Frustaci, A., Priori, S. G., Pieroni, M., Chimenti, C., Napolitano, C., Rivolta, I., … Russo, M. A. (2005). Cardiac Histological Substrate in Patients With Clinical Phenotype of Brugada Syndrome. Circulation, 112(24), 3680-3687. doi:10.1161/circulationaha.105.520999 es_ES
dc.description.references Corrado, D., Zorzi, A., Cerrone, M., Rigato, I., Mongillo, M., Bauce, B., & Delmar, M. (2016). Relationship Between Arrhythmogenic Right Ventricular Cardiomyopathy and Brugada Syndrome. Circulation: Arrhythmia and Electrophysiology, 9(4). doi:10.1161/circep.115.003631 es_ES
dc.description.references Coronel, R., Casini, S., Koopmann, T. T., Wilms-Schopman, F. J. G., Verkerk, A. O., de Groot, J. R., … de Bakker, J. M. T. (2005). Right Ventricular Fibrosis and Conduction Delay in a Patient With Clinical Signs of Brugada Syndrome. Circulation, 112(18), 2769-2777. doi:10.1161/circulationaha.105.532614 es_ES
dc.description.references Probst, V., Veltmann, C., Eckardt, L., Meregalli, P. G., Gaita, F., Tan, H. L., … Wilde, A. A. M. (2010). Long-Term Prognosis of Patients Diagnosed With Brugada Syndrome. Circulation, 121(5), 635-643. doi:10.1161/circulationaha.109.887026 es_ES
dc.description.references Baranchuk, A., Nguyen, T., Ryu, M. H., Femenía, F., Zareba, W., Wilde, A. A. M., … Pérez-Riera, A. R. (2012). Brugada Phenocopy: New Terminology and Proposed Classification. Annals of Noninvasive Electrocardiology, 17(4), 299-314. doi:10.1111/j.1542-474x.2012.00525.x es_ES
dc.description.references Littmann, L., Monroe, M. H., Taylor, L., & Brearley, W. D. (2007). The hyperkalemic Brugada sign. Journal of Electrocardiology, 40(1), 53-59. doi:10.1016/j.jelectrocard.2006.10.057 es_ES
dc.description.references Weiss, J. N., Qu, Z., & Shivkumar, K. (2017). Electrophysiology of Hypokalemia and Hyperkalemia. Circulation: Arrhythmia and Electrophysiology, 10(3). doi:10.1161/circep.116.004667 es_ES
dc.description.references Wilde, A. A. M., Postema, P. G., Di Diego, J. M., Viskin, S., Morita, H., Fish, J. M., & Antzelevitch, C. (2010). The pathophysiological mechanism underlying Brugada syndrome. Journal of Molecular and Cellular Cardiology, 49(4), 543-553. doi:10.1016/j.yjmcc.2010.07.012 es_ES
dc.description.references Zhang, J., Sacher, F., Hoffmayer, K., O’Hara, T., Strom, M., Cuculich, P., … Rudy, Y. (2015). Cardiac Electrophysiological Substrate Underlying the ECG Phenotype and Electrogram Abnormalities in Brugada Syndrome Patients. Circulation, 131(22), 1950-1959. doi:10.1161/circulationaha.114.013698 es_ES
dc.description.references Nademanee, K., Hocini, M., & Haïssaguerre, M. (2017). Epicardial substrate ablation for Brugada syndrome. Heart Rhythm, 14(3), 457-461. doi:10.1016/j.hrthm.2016.12.001 es_ES
dc.description.references Hoogendijk, M. G., Opthof, T., Postema, P. G., Wilde, A. A. M., de Bakker, J. M. T., & Coronel, R. (2010). The Brugada ECG Pattern. Circulation: Arrhythmia and Electrophysiology, 3(3), 283-290. doi:10.1161/circep.110.937029 es_ES
dc.description.references Hoogendijk, M. G., Potse, M., Linnenbank, A. C., Verkerk, A. O., den Ruijter, H. M., van Amersfoorth, S. C. M., … Coronel, R. (2010). Mechanism of right precordial ST-segment elevation in structural heart disease: Excitation failure by current-to-load mismatch. Heart Rhythm, 7(2), 238-248. doi:10.1016/j.hrthm.2009.10.007 es_ES
dc.description.references Tsuneoka, H., Takagi, M., Murakoshi, N., Yamagishi, K., Yokoyama, Y., … Xu, D. (2016). Long‐Term Prognosis of Brugada‐Type ECG and ECG With Atypical ST‐Segment Elevation in the Right Precordial Leads Over 20 Years: Results From the Circulatory Risk in Communities Study (CIRCS). Journal of the American Heart Association, 5(8). doi:10.1161/jaha.115.002899 es_ES
dc.description.references Babai Bigi, M. A., Aslani, A., & Shahrzad, S. (2007). aVR sign as a risk factor for life-threatening arrhythmic events in patients with Brugada syndrome. Heart Rhythm, 4(8), 1009-1012. doi:10.1016/j.hrthm.2007.04.017 es_ES
dc.description.references Van Oosterom, A. (2004). ECGSIM: an interactive tool for studying the genesis of QRST waveforms. Heart, 90(2), 165-168. doi:10.1136/hrt.2003.014662 es_ES
dc.description.references O’Hara, T., Virág, L., Varró, A., & Rudy, Y. (2011). Simulation of the Undiseased Human Cardiac Ventricular Action Potential: Model Formulation and Experimental Validation. PLoS Computational Biology, 7(5), e1002061. doi:10.1371/journal.pcbi.1002061 es_ES
dc.description.references Dutta, S., Mincholé, A., Quinn, T. A., & Rodriguez, B. (2017). Electrophysiological properties of computational human ventricular cell action potential models under acute ischemic conditions. Progress in Biophysics and Molecular Biology, 129, 40-52. doi:10.1016/j.pbiomolbio.2017.02.007 es_ES
dc.description.references Cardone-Noott, L., Bueno-Orovio, A., Mincholé, A., Zemzemi, N., & Rodriguez, B. (2016). Human ventricular activation sequence and the simulation of the electrocardiographic QRS complex and its variability in healthy and intraventricular block conditions. EP Europace, 18(suppl_4), iv4-iv15. doi:10.1093/europace/euw346 es_ES
dc.description.references Pelleg, A., Mitamura, H., Price, R., Kaplinsky, E., Menduke, H., Dreifus, L. S., & Michelson, E. L. (1989). Extracellular potassium ion dynamics and ventricular arrhythmias in the canine heart. Journal of the American College of Cardiology, 13(4), 941-950. doi:10.1016/0735-1097(89)90240-4 es_ES
dc.description.references Giudicessi, J. R., Ye, D., Tester, D. J., Crotti, L., Mugione, A., Nesterenko, V. V., … Ackerman, M. J. (2011). Transient outward current (Ito) gain-of-function mutations in the KCND3-encoded Kv4.3 potassium channel and Brugada syndrome. Heart Rhythm, 8(7), 1024-1032. doi:10.1016/j.hrthm.2011.02.021 es_ES
dc.description.references Garcia-Molla, V. M., Liberos, A., Vidal, A., Guillem, M. S., Millet, J., Gonzalez, A., … Climent, A. M. (2014). Adaptive step ODE algorithms for the 3D simulation of electric heart activity with graphics processing units. Computers in Biology and Medicine, 44, 15-26. doi:10.1016/j.compbiomed.2013.10.023 es_ES
dc.description.references Atienza, F., Almendral, J., Moreno, J., Vaidyanathan, R., Talkachou, A., Kalifa, J., … Berenfeld, O. (2006). Activation of Inward Rectifier Potassium Channels Accelerates Atrial Fibrillation in Humans. Circulation, 114(23), 2434-2442. doi:10.1161/circulationaha.106.633735 es_ES
dc.description.references Ettinger, P. O., Regan, T. J., & Oldewurtel, H. A. (1974). Hyperkalemia, cardiac conduction, and the electrocardiogram: A review. American Heart Journal, 88(3), 360-371. doi:10.1016/0002-8703(74)90473-6 es_ES
dc.description.references Anselm, D. D., Gottschalk, B. H., & Baranchuk, A. (2014). Brugada Phenocopies: Consideration of Morphologic Criteria and Early Findings From an International Registry. Canadian Journal of Cardiology, 30(12), 1511-1515. doi:10.1016/j.cjca.2014.09.023 es_ES
dc.description.references Guo, J., Massaeli, H., Xu, J., Jia, Z., Wigle, J. T., Mesaeli, N., & Zhang, S. (2009). Extracellular K+ concentration controls cell surface density of IKr in rabbit hearts and of the HERG channel in human cell lines. Journal of Clinical Investigation, 119(9), 2745-2757. doi:10.1172/jci39027 es_ES
dc.description.references Sakmann, B., & Trube, G. (1984). Conductance properties of single inwardly rectifying potassium channels in ventricular cells from guinea-pig heart. The Journal of Physiology, 347(1), 641-657. doi:10.1113/jphysiol.1984.sp015088 es_ES
dc.description.references Bérubé, J., Chahine, M., & Daleau, P. (1999). Modulation of HERG potassium channel properties by external pH. Pfl�gers Archiv European Journal of Physiology, 438(3), 419-422. doi:10.1007/s004240050930 es_ES
dc.description.references Junttila, M. J., Gonzalez, M., Lizotte, E., Benito, B., Vernooy, K., Sarkozy, A., … Brugada, R. (2008). Induced Brugada-Type Electrocardiogram, a Sign for Imminent Malignant Arrhythmias. Circulation, 117(14), 1890-1893. doi:10.1161/circulationaha.107.746495 es_ES
dc.description.references Postema, P. G., Vlaar, A. P. J., DeVries, J. H., & Tan, H. L. (2011). Familial Brugada syndrome uncovered by hyperkalaemic diabetic ketoacidosis. Europace, 13(10), 1509-1510. doi:10.1093/europace/eur151 es_ES
dc.description.references Smits, J. P. ., Eckardt, L., Probst, V., Bezzina, C. R., Schott, J. J., Remme, C. A., … Wilde, A. A. . (2002). Genotype-phenotype relationship in Brugada syndrome: electrocardiographic features differentiate SCN5A-related patients from non–SCN5A-related patients. Journal of the American College of Cardiology, 40(2), 350-356. doi:10.1016/s0735-1097(02)01962-9 es_ES
dc.description.references Di Diego, J. M., Cordeiro, J. M., Goodrow, R. J., Fish, J. M., Zygmunt, A. C., Pérez, G. J., … Antzelevitch, C. (2002). Ionic and Cellular Basis for the Predominance of the Brugada Syndrome Phenotype in Males. Circulation, 106(15), 2004-2011. doi:10.1161/01.cir.0000032002.22105.7a es_ES
dc.description.references GUILLEM, M. S., CLIMENT, A. M., MILLET, J., BERNE, P., RAMOS, R., BRUGADA, J., & BRUGADA, R. (2016). Spatiotemporal Characteristics of QRS Complexes Enable the Diagnosis of Brugada Syndrome Regardless of the Appearance of a Type 1 ECG. Journal of Cardiovascular Electrophysiology, 27(5), 563-570. doi:10.1111/jce.12937 es_ES


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