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

[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 prospecti...

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Autores: Rivera-Juárez, Allan, Hernández-Romero, Ismael, Puertas, Carolina, Zhang-Wang, Serena, Sánchez-Álamo, Beatriz, Martins, Raphael, Figuera, Carlos, Fernández-Avilés, Francisco, Tejedor, Alberto, Jalife, José, Atienza, Felipe, Guillem Sánchez, María Salud|||0000-0001-5660-3693, Andreu M. Climent|||0000-0002-7260-8811
Tipo de recurso: artículo
Fecha de publicación:2019
País:España
Institución:Universitat Politècnica de València (UPV)
Repositorio:RiuNet. Repositorio Institucional de la Universitat Politécnica de Valéncia
Idioma:inglés
OAI Identifier:oai:riunet.upv.es:10251/160595
Acceso en línea:https://riunet.upv.es/handle/10251/160595
Access Level:acceso abierto
Palabra clave:Brugada syndrome
Hyperkalemia
Sudden cardiac death
TECNOLOGIA ELECTRONICA
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dc.title.none.fl_str_mv Clinical Characteristics and Electrophysiological Mechanisms Underlying Brugada ECG in Patients With Severe Hyperkalemia
title Clinical Characteristics and Electrophysiological Mechanisms Underlying Brugada ECG in Patients With Severe Hyperkalemia
spellingShingle Clinical Characteristics and Electrophysiological Mechanisms Underlying Brugada ECG in Patients With Severe Hyperkalemia
Rivera-Juárez, Allan
Brugada syndrome
Hyperkalemia
Sudden cardiac death
TECNOLOGIA ELECTRONICA
title_short Clinical Characteristics and Electrophysiological Mechanisms Underlying Brugada ECG in Patients With Severe Hyperkalemia
title_full Clinical Characteristics and Electrophysiological Mechanisms Underlying Brugada ECG in Patients With Severe Hyperkalemia
title_fullStr Clinical Characteristics and Electrophysiological Mechanisms Underlying Brugada ECG in Patients With Severe Hyperkalemia
title_full_unstemmed Clinical Characteristics and Electrophysiological Mechanisms Underlying Brugada ECG in Patients With Severe Hyperkalemia
title_sort Clinical Characteristics and Electrophysiological Mechanisms Underlying Brugada ECG in Patients With Severe Hyperkalemia
dc.creator.none.fl_str_mv Rivera-Juárez, Allan
Hernández-Romero, Ismael
Puertas, Carolina
Zhang-Wang, Serena
Sánchez-Álamo, Beatriz
Martins, Raphael
Figuera, Carlos
Fernández-Avilés, Francisco
Tejedor, Alberto
Jalife, José
Atienza, Felipe
Guillem Sánchez, María Salud|||0000-0001-5660-3693
Andreu M. Climent|||0000-0002-7260-8811
author Rivera-Juárez, Allan
author_facet Rivera-Juárez, Allan
Hernández-Romero, Ismael
Puertas, Carolina
Zhang-Wang, Serena
Sánchez-Álamo, Beatriz
Martins, Raphael
Figuera, Carlos
Fernández-Avilés, Francisco
Tejedor, Alberto
Jalife, José
Atienza, Felipe
Guillem Sánchez, María Salud|||0000-0001-5660-3693
Andreu M. Climent|||0000-0002-7260-8811
author_role author
author2 Hernández-Romero, Ismael
Puertas, Carolina
Zhang-Wang, Serena
Sánchez-Álamo, Beatriz
Martins, Raphael
Figuera, Carlos
Fernández-Avilés, Francisco
Tejedor, Alberto
Jalife, José
Atienza, Felipe
Guillem Sánchez, María Salud|||0000-0001-5660-3693
Andreu M. Climent|||0000-0002-7260-8811
author2_role author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Departamento de Ingeniería Electrónica
Escuela Técnica Superior de Ingeniería de Telecomunicación
Instituto Universitario de Tecnologías de la Información y Comunicaciones
European Regional Development Fund
Ministerio de Economía y Competitividad
Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares
Repositorio Institucional de la Universitat Politècnica de València Riunet
dc.subject.none.fl_str_mv Brugada syndrome
Hyperkalemia
Sudden cardiac death
TECNOLOGIA ELECTRONICA
topic Brugada syndrome
Hyperkalemia
Sudden cardiac death
TECNOLOGIA ELECTRONICA
description [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.
publishDate 2019
dc.date.none.fl_str_mv 2019
2019-02-05
dc.type.none.fl_str_mv journal article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://riunet.upv.es/handle/10251/160595
url https://riunet.upv.es/handle/10251/160595
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.relation.none.fl_str_mv Ministerio de Economía y Competitividad http://dx.doi.org/10.13039/501100003329 PI14%2F00857 Caracterización No-invasiva de los Mecanismos de Mantenimiento de la Fibrilación Auricular. Estudio PERSONALIZE-AF
Ministerio de Economía y Competitividad http://dx.doi.org/10.13039/501100003329 TEC2013-46067-R ESTIMACION NO INVASIVA DE LA ACTIVIDAD ELECTRICA CARDIACA MEDIANTE OPTIMIZACION CONVEXA
Instituto de Salud Carlos III https://doi.org/10.13039/501100004587 PI17%2F01059 Estratificación y tratamiento de la fibrilación auricular basada en los mecanismos de perpetuación de la arritmia
Instituto de Salud Carlos III https://doi.org/10.13039/501100004587 DTS16%2F0160
Instituto de Salud Carlos III https://doi.org/10.13039/501100004587 PI17%2F01106 Estratificación y tratamiento de la fibrilación auricular basada en los mecanismos de perpetuación de la arritmia
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
Reconocimiento - No comercial (by-nc)
http://creativecommons.org/licenses/by-nc/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
Reconocimiento - No comercial (by-nc)
http://creativecommons.org/licenses/by-nc/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv John Wiley & Sons
publisher.none.fl_str_mv John Wiley & Sons
dc.source.none.fl_str_mv reponame:RiuNet. Repositorio Institucional de la Universitat Politécnica de Valéncia
instname:Universitat Politècnica de València (UPV)
instname_str Universitat Politècnica de València (UPV)
reponame_str RiuNet. Repositorio Institucional de la Universitat Politécnica de Valéncia
collection RiuNet. Repositorio Institucional de la Universitat Politécnica de Valéncia
repository.name.fl_str_mv
repository.mail.fl_str_mv
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spelling Clinical Characteristics and Electrophysiological Mechanisms Underlying Brugada ECG in Patients With Severe HyperkalemiaRivera-Juárez, AllanHernández-Romero, IsmaelPuertas, CarolinaZhang-Wang, SerenaSánchez-Álamo, BeatrizMartins, RaphaelFiguera, CarlosFernández-Avilés, FranciscoTejedor, AlbertoJalife, JoséAtienza, FelipeGuillem Sánchez, María Salud|||0000-0001-5660-3693Andreu M. Climent|||0000-0002-7260-8811Brugada syndromeHyperkalemiaSudden cardiac deathTECNOLOGIA ELECTRONICA[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.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).John Wiley & SonsDepartamento de Ingeniería ElectrónicaEscuela Técnica Superior de Ingeniería de TelecomunicaciónInstituto Universitario de Tecnologías de la Información y ComunicacionesEuropean Regional Development FundMinisterio de Economía y CompetitividadCentro de Investigación Biomédica en Red Enfermedades CardiovascularesRepositorio Institucional de la Universitat Politècnica de València Riunet20192019-02-05journal articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://riunet.upv.es/handle/10251/160595reponame:RiuNet. Repositorio Institucional de la Universitat Politécnica de Valénciainstname:Universitat Politècnica de València (UPV)InglésengMinisterio de Economía y Competitividad http://dx.doi.org/10.13039/501100003329 PI14%2F00857 Caracterización No-invasiva de los Mecanismos de Mantenimiento de la Fibrilación Auricular. Estudio PERSONALIZE-AFMinisterio de Economía y Competitividad http://dx.doi.org/10.13039/501100003329 TEC2013-46067-R ESTIMACION NO INVASIVA DE LA ACTIVIDAD ELECTRICA CARDIACA MEDIANTE OPTIMIZACION CONVEXAInstituto de Salud Carlos III https://doi.org/10.13039/501100004587 PI17%2F01059 Estratificación y tratamiento de la fibrilación auricular basada en los mecanismos de perpetuación de la arritmiaInstituto de Salud Carlos III https://doi.org/10.13039/501100004587 DTS16%2F0160Instituto de Salud Carlos III https://doi.org/10.13039/501100004587 PI17%2F01106 Estratificación y tratamiento de la fibrilación auricular basada en los mecanismos de perpetuación de la arritmiaopen accesshttp://purl.org/coar/access_right/c_abf2Reconocimiento - No comercial (by-nc) http://creativecommons.org/licenses/by-nc/4.0/info:eu-repo/semantics/openAccessoai:riunet.upv.es:10251/1605952026-06-13T07:49:27Z
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