臨床検査51巻7号

2007年07月発行

今月の主題 不整脈検査 不整脈と疾病

Brugada症候群

著者： 西崎光弘¹

所属機関： ¹横浜南共済病院循環器内科

ページ範囲：P.743 - P.751

　Brugada症候群は心電図上，V₁～V₃誘導において特徴的なST上昇波形(Coved型およびSaddleback型ST上昇)を示し，心室細動により突然死をきたす疾患として知られている．病態は右室流出路領域における心内膜細胞と心外膜細胞の活動電位の勾配に起因すると考えられている．本疾患はST上昇波形の心電図所見に基づいて診断され，薬物負荷試験や電気生理学的検査などの検査を用いて，症候性および家族歴の有無により，植え込み型除細動器治療の適応などの治療方針が決定される．

参考文献

1) Brugada P, Brugada J：Right bundle branch block, persistent ST-segment elevation and sudden cardiac death：A distinct clinical and electrocardiographic syndrome：A multicenter report. J Am Coll Cardiol 20：1391-1396, 1992

2) Brugada J, Brugada R, Brugada P：Right bundle-branch block and ST-segment elevation in leads V1 through V3. A marker for sudden death in patients without demonstrable structural heart disease. Circulation 97：457-460, 1998

3) Gussak I, Antzelevitch C, Bjerregaard P, et al：The Brugada syndrome：clinical, electrophysiologic and genetic aspect. J Am Coll Cardiol 33：5-15, 1999

4) Atarashi H, Ogawa S, Harumi K, et al：Three-year follow-up of patients with right bundle branch block and ST-segment elevation in the right precordial leads：Japanese Registration of Brugada syndrome：Idiopathic Ventricular Fibrillation Investigators. J Am Coll Cardiol 37：1916-1920, 2001

5) Matsuo K, Akahoshi M, Nakashima E, et al：The prevalence, incidence and prognostic value of the Brugada-type electrocardiogram：a population-based study of four decades. J Am Coll Cardiol 38：765-770, 2001

6) Miyazaki T, Mitamura H, Miyoshi S, et al：Autonomic and antiarrhythmic drug modulation of ST-segment elevation in patients with Brugada syndrome. J Am Coll Cardiol 27：1061-1070, 1996

7) Yan GX, Antzelevitch C：Cellular basis for the electrocardiographic J wave. Circulation 93：372-379, 1996

8) Yan GX, Antzelevitch C：Cellular basis for the Brugada syndrome and other mechanisms of arrhythmogenesis associated with ST-segment elevation. Circulation 10：1660-1666, 1999

9) Gussak I, Antzelevitch C：Early repolarization syndrome：Clinical characteristics and possible cellular and ionic mechanisms. J Electrocardiol 33：299-309, 2000

10) Antzelevitch C：The Brugada syndrome：Ionic basis and arrhythmia mechanism. J Cardiovasc Electrophysiol 12：268-272, 2001

11) Morita H, Morita ST, Nagase S, et al：Ventricular arrhythmia induced by sodium channel blocker in patients with Brugada syndrome. J Am Coll Cardiol 42：1624-1631, 2003

12) Jeffrey M, Fish DVM, Antzelevitch C：Role of sodium and calcium channel block in unmasking the Brugada syndrome. Heart Rhythm 1：210-217, 2004

13) Nishizaki M, Fujii H, Sakurada H, et al：Spontaneous T wave alternans in a patient with Brugada syndrome-Responses to intravenous administration of class I antiarrhythmic drug, glucose tolerance test and atrial pacing. J Cardiovasc Electrophysiol 16：216-219, 2005

14) Nishizaki M, Sakurada H, Yamawake N, et al：Influence of taking meals on circadian changes of ST-segment elevation on 12 lead ECG in the Brugada syndrome. Circulation(Supplement II) 112：II-703, 2005

15) 西崎光弘，宮地浩太郎，藤井洋之，他：12誘導心電図によるBrugada症候群における日内変動の検討．心電図 25(Supple4)：69-73, 2005

16) Shimizu W, Matsuo K, Takagi M, et al：Body surface distribution and response to drugs of ST segment elevation in Brugada syndrome：Clinical implication of eighty-seven-lead body surface potential mapping and its application to twelve-lead electrograms. J Cardiovasc Electrophysiol 11：396-404, 2000

intercostals space and prevalence of Brugada-type ECG in accordance with recently established electrocardiographic criteria. Circ J 68：135-138, 2004

18) Ikeda T, Sakurada H, Sakabe K, et al：Assessment of noninvasive markers in identifying patients at risk in the Brugada syndrome：Insight into risk stratiflcation. J Am Coll Cardiol 37：1628-1634, 2001

19) Mizumaki K, Fujiki A, Sakabe M, et al：Vagal activity modulates spontaneous augmentation of ST elevation in the daily life of patients with Brugada syndrome. J Cardiovasc Electrophysiol 15：667-673, 2004

20) Brugada R, Brugada J, Antzelevitch C, et al：Sodium channel blockers identify risk for sudden death in patients with ST-segment elevation and right bundle branch block but structurally normal hearts. Circulation 101：510-515, 2000

21) Morita H, Morita ST, Nagase S, et al：Ventricular arrhythmia induced by sodium channel blocker in patients with Brugada syndrome. J Am Coll Cardiol 42：1624-1631, 2003

22) Wilde AAM, Antzelevitch C, Borggrefe M, et al：Proposed diagnostic criteria for the Brugada syndrome：Consensus report. Circulation 106：2514-2519, 2002

23) Antzelevitch C, Brugada P, Borggrefe M, et al：Brugada syndrome：Report of second consensus conference. Circulation 111：659-670, 2005

24) Nishizaki M, Sakurada H, Ashikaga T, et al：Effects of glucose-induced insulin secretion on ST segment elevation in the Brugada syndrome. J Cardiovasc Electrophysiol 14：243-249, 2003

25) Brugada P, Brugada R, Mont L, et al：Natural history of Brugada syndrome：The prognostic value of programmed electrical stimulation of the heart. J Cardivasc Electrophysiol 14：455-457, 2003

26) Eckardt L, Probst V, Smits JPP, et al：Long-term prognosis of individuals with right precordial ST-segment elevation Brugada syndrome. Circulation 111：257-263, 2005

27) 西崎光弘，杉薫，泉田直己，他：本邦におけるBrugada症候群に対する心電図自動診断基準―日本心電学会：Brugada症候群自動診断ワーキンググループによる報告．心電図 26：758-767，2006

28) Tsuchiya T, Ashikaga K, Honda T, et al：Prevention of ventricular flbrillation by cilostazol, an oral phosphodiesterase inhibitor, in a patient with Brugada syndrome. J Cardiovasc Electrophysiol 13：698-701, 2002

29) Hermida JS, Denjoy I, Clerc J, et al：Hydroquinidine therapy in Brugada syndrome. J Am Coll Cardiol 43：1853-1860, 2004

30) Belhassen B, Glick A, Viskin S：Efficacy of quinidine in High-risk patients with Brugada syndrome. Circulation 110：1731-1737, 2004

31) Mizusawa Y, Sakurada H, Nishizaki M, et al：Effects of low-dose quinidine on ventricular tachyarrhythmias in patients with Brugada syndrome：low-dose quinidine therapy as an adjunctive treatment. J Cardiovasc Pharmacol 47：359-364, 2006

32) Watanabe A, Fukushima Kusano K, Morita H, et al：Low-dose isoproterenol for repetitive ventricular arrhythmia in patients with Brugada syndrome. Eur Heart J 27：1579-1583, 2006