213 Prevalence and prognosis role of type 1 ST elevation in limb ECG leads in patients with Brugada syndrome

Abstract Introduction Brugada syndrome (BrS) is an inherited arrhythmia syndrome with an increased risk of sudden cardiac death (SCD). The recent single lead-based diagnosis of Brugada syndrome recommended criterion may lead to overdiagnosis of Brugada syndrome and overestimation of the risk of SCD. Objective We aim to investigate the value of a single lead diagnosis in spontaneous type 1 ECG Brugada patient and to investigate the association between the number of ECG leads with a spontaneous type 1 ST elevation and the arrhythmic risk. Methods Consecutive patients affected with BrS were recruited in a multicentric prospective registry in France (15 centers) between 1994 and 2016. A total of 1613 patients affected by the Brugada syndrome were enrolled. For this specific study, only patient with a spontaneous type 1 BrS were enrolled (n=505). Data were prospectively collected with an average follow-up of 6.5±4.7 years. ECGs were reviewed by 2 physicians blinded to clinical status. Type 1 ST elevation was defined by ≥2 mm J-point elevation with coved ST segment and negative T wave. Results A total of 505 patients with a spontaneous type 1 BrS (mean age 46±15 years, 398 males, 79%) were enrolled. 117 patients (23%) were symptomatic at baseline (32 (6%) aborted SCD, 85 (17%) syncope). Implantable cardiac defibrillator (ICD) was implanted in 191 patients (38%). Brugada ECG pattern was found in 1 lead in 250 patients (50%, group 1), in 2 leads in 227 patients (45%, group 2) and in 3 leads in 28 patients (5%, group 3). Groups were comparable in term of clinical presentation except for group 3 who presented more frequently an early repolarization pattern (n=19 (8%) in group 1, n=15 in group 2 (6%) and n=7 (25%) in group 3, p=0.02) and more frequently QRS fragmentation (n=6 (2%) in group 1, n=3 in group 2 (1%) and n=3 (11%) in group 3, p=0.03). During follow-up, 46 (9%) patients presented an arrhythmic event: 22 (9%) in group 1 (4 SCD, 14 appropriate ICD therapy, 4 ventricular arrhythmias), 22 (10%) in group 2 (6 SCD, 11 appropriate ICD therapy, 5 ventricular arrhythmias) and 2 (7%) in group 3 (1 SCD, 1 appropriate ICD therapy). Patients with type 1 BrS pattern in 2 or 3 ECG leads had not a significantly higher rate of arrhythmic events than patients with type 1 BrS pattern in only 1 ECG lead (HR: 1.1; 95% CI: 0.6–1.9 for group 2 and HR: 0.7; 95% CI: 0.2–3 for group 2; p=0,087). Conclusion In the largest cohort of BrS patients ever described, the prognosis of Brugada syndrome with a spontaneous ECG pattern does not appear to be affected by the number of leads required for diagnostic.

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P947dST-Tiso index, a new shallow ECG marker in response to ajmaline for predicting ventricular fibrillation induction in Brugada patients

EP Europace ◽

10.1093/europace/euaa162.061 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

S Iacopino ◽

P Sorrenti ◽

G Fabiano ◽

G Campagna ◽

A Petretta ◽

...

Keyword(s):

Risk Factors ◽

Ventricular Fibrillation ◽

Brugada Syndrome ◽

Drug Induced ◽

Non Invasive ◽

T Wave ◽

First Case ◽

Potential Risk Factors

Abstract Introduction - No study has been performed to investigate the role of drug-induced ECG morphology modifications as potential risk factors for the development of malignant arrhythmias in patients with Brugada syndrome. Purpose - The aim of this study is to introduce a new index to improve asymptomatic patient stratification and to report the first case of a patient with Brugada syndrome undergoing ajmaline testing that has been evaluated using a diagnostic 252-lead ECG vest. Methods - From December 2018 to April 2019, 26 consecutive patients [mean age 39.9 (30–59) years, 18 male] with no cardiovascular risk factors underwent ajmaline testing. By evaluating ECG recordings after ajmaline administration, we calculated an index that we called "dST-Tiso", that is the duration of the positive component of the ST-T wave to the isoelectric line, in V1 and/or V2. Results- Out of 26 patients, 16 (61.5%) had a positive test, with type 1 (coved-type) ECG diagnostic pattern in leads V1-V2 from the 2nd, 3rd and 4th intercostal spaces. The mean recorded dST-Tiso value was 239 ± 76 ms. The ECG showed T-wave above the isoelectric line in 5 patients with a significantly higher dST-Tiso value (on average 360 ± 56 ms), and biphasic T-waves below the isoelectric line in 11 patients with a dST-Tiso value of 209 ± 42 ms (Mann-Whitney, p = 0.039). All patients with positive ajmaline test underwent programmed electrical stimulation (PES). Ventricular fibrillation was induced during PES in all 5 patients with stretched dST-Tiso. In the remaining 11 patients without stretched dST-Tiso, no ventricular arrhythmia was induced by PES. Fig 1 Moreover, using non-invasive high-density electrocardiographic mapping (252-lead ECG vest), 3 patients with dST-Tiso positive pattern received a second ajmaline protocol, with assessment of both the depolarization and repolarization phases. Conclusion - The ECG pattern of prolonged dST-Tiso seems to have a significant impact on safety during PES and may have potential for stratifying risk of sudden death in patients with PES-induced ventricular tachycardia/fibrillation. Abstract Figure 1. Patients’ flowchart.

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Abstract 1832: Location of Making Type 1 Electrocardiogram in Brugada Syndrome: Comparison between Lead Position and Anatomical Location of Right Ventricular Outflow Tract

Circulation ◽

10.1161/circ.116.suppl_16.ii_391-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Satoshi Nagase ◽

Shigeki Hiramatsu ◽

Nobuhiro Nishii ◽

Masato Murakami ◽

Takeshi Tada ◽

...

Keyword(s):

Brugada Syndrome ◽

Channel Blocker ◽

Right Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Anatomical Location ◽

Sodium Channel Blocker ◽

Fluoroscopic Image ◽

Ecg Leads ◽

The Relationship

Introduction: Recording type 1 ECG in right precordial leads in the presence or absence of a sodium channel blocker is a diagnostic criterion in Brugada syndrome (BrS). It was also suggested that right ventricular outflow tract (RVOT) is the arrhythmogenic substrate in BrS. However, we occasionally observed type 1 ECG only in the third intercostal space (3ics), not standard fourth intercostal space (4ics). Accordingly, we examined the relationship between the position of ECG leads manifesting type 1 and anatomical location of RVOT under fluoroscopic image. Methods: Total 33 BrS patients were examined in this study. All patients had more than one of the following: documented ventricular fibrillation (VF), several episodes of syncope, a family history of sudden death, SCN5A mutation or inducibility of VF by programmed electrical stimulation. Anatomical location of the RVOT was determined under fluoroscopic image with right ventriculography. ECG was also recorded at the 3ics in leads V1 and V2 in addition to the standard V1 and V2 at the 4ics with fluoroscopically visible electrodes. A pure sodium channel blocker, pilsicainide, was administered in all patients without manifesting type 1 ECG under baseline conditions. Relationships between anatomical location and the position of ECG leads manifesting type 1 were examined in all patients. Results: Type 1 ECG was recorded in all patients with pilsicainide administration. The location of RVOT corresponded with lead V1 and V2 at the 4ics in 5 patients and at the 3ics in 28 patients. In 4 out of 5 patients (80.0%) corresponding RVOT with 4ics, type 1 ECG was recorded at the 4ics. However, in 24 out of 28 patients (85.7%) corresponding RVOT with 3ics, type 1 ECG was recorded only at the 3ics. Furthermore, in 7 out of 12 symptomatic patients (58.3%) with documented VF or syncope, type 1 ECG was not recorded at the 4ics, however, could be detected at the 3ics without pilsicainide administration. The location of RVOT was not different between symptomatic and asymptomatic patients. Conclusions: Type 1 ECG is predominantly caused at the RVOT, and the relationship between the position of ECG lead and the RVOT is variable. Recording ECG at the 3ics in addition to the standard 4ics in the right precordial leads is convincing in diagnosis of BrS.

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P5027Prognosis and evaluation of the risk markers of arrhythmia in a large population of Brugada syndrome patients

European Heart Journal ◽

10.1093/eurheartj/ehz746.0205 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

V Probst ◽

S Anys ◽

F Sacher ◽

J Briand ◽

B Guyomarch ◽

...

Keyword(s):

Brugada Syndrome ◽

Ventricular Arrhythmias ◽

Clinical Status ◽

Large Population ◽

Fragmented Qrs ◽

Increased Risk ◽

Inherited Arrhythmia ◽

St Elevation

Abstract Introduction Brugada syndrome (BrS) is an inherited arrhythmia syndrome with an increased risk of sudden cardiac death (SCD) despite a structurally normal heart. Many parameters have been suggested to be associated with the risk of ventricular arrhythmias, but only previous symptoms and spontaneous ECG pattern have been consistently associated with the risk of ventricular arrhythmia occurrence. Objective The aim of this study was to evaluate the association of these parameters with arrhythmic events in the largest cohort of BrS patients ever described. Methods Consecutive patients affected with BrS were recruited in a multicentric prospective registry in France (15 centers) between 1994 and 2016. Data were prospectively collected with an average follow-up of 6.5±4.7 years. ECGs were reviewed by 2 physicians blinded to clinical status. Results In this study, we enrolled a total of 1613 patients (mean age 45±15 years; 1119 males, 69%). At baseline, 462 patients (29%) were symptomatic (51 (3%) aborted SCD, 257 (16%) syncope). A spontaneous type 1 ECG pattern was present in 505 patients (31%). Implantable cardiac defibrillator was implanted in 477 patients (30%). During the follow-up, 91 patients (6%) underwent arrhythmic events (16 SCD (10%), 48 appropriate ICD therapy (3%) and 27 ventricular arrhythmias (2%). Thirty-six patients (2%) died of non-arrhythmic causes. Mean age at the first event was 44±15 years. In our cohort, event predictors were SCD (HR: 18.3; 95% CI: 11.2–29.8; p<0.0001), syncope (HR: 2.9; 95% CI: 1.8–4.9; p<0.0001), age >60 years (HR: 0.11; 95% CI: 0.032–0.377; p=0,0004), gender (HR: 2.96; 95% CI: 1.6–5.4; p=0.0005), spontaneous type 1 (HR: 2.14; 95% CI: 1.42–3.23; p=0.0003), type 1 ST elevation in peripheral ECG lead (HR: 3.6; 95% CI: 1.9–7.1; p=0,0001), fragmented QRS (HR: 3.37; 95% CI: 1.37–8.32; p=0,008), AvR sign (HR: 2.2; 95% CI: 1.4–3.8; p=0,0007), QRS >120ms in D2 lead (HR: 2.2; 95% CI: 1.4–3.6; p=0,001) and QRS >90ms in V6 (HR: 2.1; 95% CI: 1.3–3.3; p=0,001). All the others parameters including early repolarization pattern (ERP) and EPS were not predictor of events. Conclusion In the largest cohort of BrS patients ever described, we confirmed that symptoms, age, gender, spontaneous type 1, type 1 ST elevation in peripheral ECG lead, fragmented QRS, AvR sign, QRS >120ms in D2 and QRS >90ms in V6 are associated with arrhythmic events whereas ERP and EPS were not.

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