論文種別	原著(症例報告除く)
言語種別	英語
査読の有無	その他(不明)
表題	Clinical Profile and Mode of Initiation of Spontaneous Ventricular Tachyarrhythmias in Patients With Brugada Syndrome (START-BrS).
掲載誌名	正式名：JACC. Clinical electrophysiology 略　 称：JACC Clin Electrophysiol ISSNコード：24055018/2405500X
掲載区分	国外
巻・号・頁	pp.Online ahead of print
著者・共著者	Anat Milman, Koonlawee Nademanee, Tsukasa Kamakura, Gil Marcus, Nitinan Chimparlee, Krittawat Sukhabote, Takeshi Aiba, Juan Sieira, Carlo de Asmundis, Chiara Scrocco, Annamaria Martino, Deepthi Rajan, Federico Migliore, Déborah Foltran, Dana Viskin, Markus Stuehlinger, Eusebio Garcia-Izquierdo, Konstantinos P Letsas, Petr Peichl, F Javier García Fernández, Johannes Steinfurt, Julian O M Ormerod, Eric Schulze-Bahr, Jean Baptiste Gourraud, Stephen P Page, Alessandra Pia Porretta, Beat Schär, Giulio Conte, Paul Lustig, Georgia Sarquella-Brugada, Stepan Havranek, Ayelet Shauer, Masahiko Takagi, Gi-Byoung Nam, Udi Chorin, Mikael Laredo, Nicolò Martini, Jacob Tfelt-Hansen, Leonardo Calò, Elijah R Behr, Luigi Pannone, Kengo Kusano, Bernard Belhassen
発行年月	2026/03
概要	BACKGROUND:Data on the spontaneous onset of ventricular tachyarrhythmias (VTAs) in Brugada syndrome (BrS), including polymorphic ventricular tachycardia (PVT) and monomorphic ventricular tachycardia (MVT), remain limited.OBJECTIVES:The goal of this study was to compare the clinical profile and mode of initiation of PVT and MVT in BrS.METHODS:This retrospective multicenter registry included 154 patients with BrS from 29 centers with documented VTA initiation captured by implantable cardioverter-defibrillator (94.9%) or electrocardiogram (5.1%). A total of 234 VTAs were analyzed, and initiation patterns were classified by using predefined electrocardiographic criteria.RESULTS:PVT was observed in 80.5% of patients, MVT in 16.9%, and both in 2.6%. Patients with MVT tended to be older, exhibit drug-induced Brugada electrocardiogram, and were more frequently White. Pause-dependent initiation occurred in approximately 25% of PVT and approximately 33% of MVT episodes. Coupling intervals initiating PVT were nonsignificantly shorter than for MVT (median 368 milliseconds vs 395 milliseconds), with a significantly lower prematurity index and faster early arrhythmia cycle length. Antecedent premature ventricular complexes were present in approximately 43% of both VTA types, commonly sharing morphology with the initiating premature ventricular complex. The prevalence of pathogenic/likely pathogenic SCN5A mutation did not differ between groups.CONCLUSIONS:In this largest analysis to date of spontaneous VTA onset in BrS, MVT occurred in a substantial minority and was associated with older age, White ethnicity, drug-induced electrocardiogram pattern, and a preceding tachycardia. Initiation patterns were broadly similar across arrhythmia types, although PVT exhibited a significantly lower prematurity index and faster early cycle length despite only nonsignificant shorter coupling intervals. These findings refine the clinical and electrophysiological characterization of BrS-related arrhythmias and delineate distinct features of PVT and MVT initiation.
DOI	10.1016/j.jacep.2026.02.038
PMID	41979546