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(Circulation. 1998;97:937-940.)
© 1998 American Heart Association, Inc.

Correspondence

Increased Vagal Activity in Idiopathic VF

Sami Viskin, MD; ; Bernard Belhassen, MD

Sourasky-Tel Aviv Medical Center, Tel Aviv, Israel

To the Editor:

In the May 6, 1997, issue of Circulation, Kasanuki et al¹ reported a "new mechanism of idiopathic ventricular fibrillation (VF)," ie, "increased vagal activity," in patients who had VF in the absence of organic heart disease and had the "Brugada sign" ("rSR' and ST elevation" in the precordial leads).² Before we accept their proposed mechanism as "new" and their patient characteristics as "different," a few observations are pertinent:

1. The patients described were (presumably) of Asian origin; almost all (five of six) were males; and all the male patients had VF while sleeping or resting (at an unspecified time of the day). Yet the literature on the syndrome of nocturnal sudden death in southeast Asian males^{3 4 5} was ignored by the authors and by the reviewers of this article. It is important to point out this omission in view of some evidence linking the "nocturnal sudden death syndrome" and the "Brugada sign."⁶

2. Our own work⁷ was quoted to support the authors' statement that in idiopathic VF, "ventricular arrhythmias are exacerbated by psychological and physical stress." In fact, we have stated that only a minority of patients with idiopathic VF have symptomatic arrhythmias during any form of stress.^{7 8}

3. The authors' assertion that "vagal hyperactivity" is the mechanism underlying the onset of spontaneous VF in their patients is supported by scarce data: (1) the sinus rate preceding VF was not reported, and (2) the "abrupt rise in high frequency (HF) values" during heart rate variability assessment was seen . . . [Full Text of this Article]

Hiroshi Kasanuki, MD; Naoki Matuda, MD; ; Satoshi Ohnishi, MD

Department of Cardiology, The Heart Institute of Japan, Tokyo, Japan

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