A comprehensive electrocardiographic, molecular, and echocardiographic study of Brugada syndrome: Validation of the 2013 diagnostic criteria

Clinical Presentation and Outcome of Brugada Syndrome Diagnosed With the New 2013 Criteria

“…The possibility of achieving greater diagnostic sensitivity with High‐ICS leads had been suggested by several authors and electroanatomic studies identified its rationale . It is worth noting that the 2 leading pathophysiological hypotheses for BrS (repolarization hypothesis and depolarization hypothesis) agree on the idea that the pathologic substrate of BrS is localized at the level of the RVOT.…”

“…Of note, Miyamoto did not exclude patients diagnosed also in fourth intercostal space (i.e., those with diagnostic coved ST‐segment elevation in both standard and High‐ICS). A similar approach was also used by Savastano et al . Therefore, there is a remarkable difference of ECG presentation.…”

Brugada syndrome

“…Several studies have demonstrated that elevating leads V1-2 to the third and second intercostal spaces increases the sensitivity of the ECG for diagnosis of BrS [30][31][32]. This is thought to be the result of the location of the right ventricular outflow tract in the chest [31,32] and its role in the pathophysiology of BrS [33].…”

“…This is thought to be the result of the location of the right ventricular outflow tract in the chest [31,32] and its role in the pathophysiology of BrS [33]. Some data suggest that the prognosis of BrS patients remains the same irrespective of the intercostal space used for diagnosis [31].…”

Brugada Syndrome Diagnosed from the ECG Leads in the High Intercostal Spaces: Searching for Answers from a Higher Source?

“…showed that the RVOT was located over the 3rd ICS in all patients in their cohort and that the location of the type I ECG highly correlated with the anatomic location of the RVOT . Savastano et al . showed that a diagnostic Brugada ECG was present exclusively in the high ICS in 44% of patients in their cohort.…”