Narrow Anteroposterior Thorax may be Associated with Brugada Syndrome
due to Chronic Mechanical Compression of the Right Ventricular Outflow
Tract
Abstract
Introduction: Recent research has shown that Brugada syndrome (BrS) is
associated with interstitial fibrosis in the right ventricular outflow
tract (RVOT) epicardium, thus suggesting that BrS does not just involve
cardiac channelopathy but also includes cardiomyopathy. On the other
hand, Brugada pattern ECGs are often observed in patients with pectus
excavatum. The purpose of this study was to investigate whether thoracic
deformity, along with mechanical compression of RVOT, were associated
with BrS. Methods and Results: We recruited 17 male patients with
symptomatic BrS, 32 male patients with asymptomatic BrS, and 30
age-matched male controls. Using computed tomography (CT) scans, we
measured the maximal internal transverse diameter of the thorax (T) and
the shortest anteroposterior depth from the internal aspect of the
sternum to the anterior cortex of the vertebral body (D) at the level of
the RVOT. We then evaluated the fragmented QRS (f-QRS) in the right
precordial leads. D was significantly shorter, while T divided by D
(T/D) was significantly greater, in patients with symptomatic and
asymptomatic BrS than in the controls. Six patients with pectus
excavatum (T/D≥3.25) were included in the BrS population. The f-QRSs was
more frequently observed in symptomatic and asymptomatic BrS patients
than in controls. The positive spikes within the QRS complex were more
prevalent in patients with a greater T/D. Conclusion: Our results
suggested that a narrow anteroposterior thoracic space could be
associated with BrS via mechanical compression of the RVOT.