A New Electrocardiographic Marker of Sudden Death in Brugada Syndrome

Calò, Leonardo; Giustetto, Carla; Martino, Annamaria; Sciarra, Luigi; Cerrato, Natascia; Marziali, Marta; J, Rauzino; Carlino, Giorgio; Ruvo, Ermenegildo De; Guerra, Federico; Rebecchi, Marco; Lanzillo, Chiara; Anselmino, Matteo; Castro, Antonio; Turreni, Federico; Penco, María; Volpe, Massimo; Capucci, Alessandro; Gaïta, Fiorenzo

doi:10.1016/j.jacc.2016.01.024

Cited by 137 publications

(99 citation statements)

References 37 publications

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“…A). We evaluated specific ECG morphologies and arrhythmias and conduction disturbances associated with the Brugada syndrome: type 1 ECG at leads V1 and V2 with standard electrode positions and leads V1‐V2 positioned at the third intercostal space, fragmented QRS (fQRS), complete right bundle branch block (CRBBB), inferolateral early repolarization (ER), late R’ wave of lead aVR (aVR sign) and S wave in lead I . Spontaneous type 1 was defined as appearance of coved type ECG (J point ≥0.2 mV) without pilsicainide test (intravenous injection, 0.1 mg/kg/10 minute).…”

Section: Methodsmentioning

confidence: 99%

Identification of electrocardiographic risk markers for the initial and recurrent episodes of ventricular fibrillation in patients with Brugada syndrome

Morita

Watanabe

Kawada

et al. 2017

Cardiovasc electrophysiol

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Introduction: New onset of ventricular fibrillation (VF) in asymptomatic patients with Brugadatype ECG is not frequent, but it cannot be negligible. Risk markers for predicting VF are usually based on results of analysis in symptomatic patients, and they have not been determined for asymptomatic patients. We analyzed ECG markers in patients with Brugada syndrome to differentiate the risk factors for VF in both symptomatic and asymptomatic patients. Methods:The subjects were 471 patients with Brugada syndrome and we divided the subjects into two groups: Asymptomatic group (n = 326) and Symptomatic group (syncope: n = 122, VF: n = 23). We analyzed the following ECG markers: RR, PQ, QRS, QT and Tpeak-Tend (Tpe) intervals, ST level, atrial fibrillation (AF), atrioventricular block, spontaneous type 1 ECG, early repolariza- tion (ER) and fragmented QRS (fQRS).Results: During follow-up (91 ± 64 months), 41 patients experienced VF (Asymptomatic: n = 10, Symptomatic: n = 31). Univariable analysis showed that spontaneous type 1 ECG, Tpe interval (≥95 milliseconds), high ST level (≥0.52 mV) and fQRS were common predictors for VF in both the Asymptomatic and Symptomatic groups. In addition to the common risk factors, wide QRS (≥107 milliseconds), long QT interval (≥420 milliseconds), ER and AF were predictors for VF in Symptomatic group. Multivariable analysis of the Symptomatic group showed fQRS, Tpe and ER were independent predictors of prognosis.Conclusions: fQRS and Tpe interval are common risk factors for VF in both asymptomatic and symptomatic patients, whereas ER is a predictor for recurrent VF.

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Section: Methodsmentioning

confidence: 99%

Identification of electrocardiographic risk markers for the initial and recurrent episodes of ventricular fibrillation in patients with Brugada syndrome

Morita

Watanabe

Kawada

et al. 2017

Cardiovasc electrophysiol

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“…Recently, Calo et al., supporting the ‘depolarization hypothesis’, suggested the presence of a large/wide S wave in lead I to be a powerful predictor of life-threatening ventricular arrhythmias in patients with Brugada Syndrome [29]. According to the study by Calo et al., delayed activation of the RVOT in Brugada syndrome resulted in S wave in Lead I akin to patients with RBBB who also have S wave in Lead I.…”

Section: Discussionmentioning

confidence: 96%

Evaluation of baseline ECG in patients undergoing Oral Flecainide Challenge test for suspected Brugada Syndrome: An analysis of lead II

Maneesh

Prabhu

Shenthar

et al. 2017

Indian Pacing and Electrophysiology Journal

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Background and ObjectivesWe analyzed Lead II in patients undergoing an Oral Flecainide Challenge test (FCT), to identify any pointers that could predict a positive FCT and thereby help in recognition of latent BS.MethodsThe following parameters in lead II were retrospectively analyzed from the pre-test ECG in 62 patients undergoing FCT for suspected BS: The presence or absence of S waves, S wave amplitude, duration and upslope duration; J point parameters- Early repolarization, QRS notch, and QRS Slur; ST segment parameters-lack of isoelectric ST segment, ST duration and QT interval.Results48 had positive FCT (Group-1) while 14 were negative for FCT(Group-2). Lack of an isoelectric ST segment (50% vs 14.29%, p = 0.018) and slurring of QRS (33.33% vs 0%, p = 0.014) was more common in Group-1 than Group-2. Group-1 had shorter ST segment duration (median 81.5 (IQR 64–103.5) vs 110 (IQR 90–132), p = 0.002) and shorter ST: QT ratio (median 0.28 (IQR 0.22–0.35) vs 0.23 (0.18–0.27), p = 0.007). QRS notch/depressed J point (87.5%), QRS slur (100%), and lack of isoelectric ST segment (92.31%) had high sensitivity for predicting an inducible Type 1 Brugada pattern. Combining two parameters- ST: QT ratio<0.24 and lack of isoelectric ST segment-considerably improved the specificity (73.3%), and the positive predictive value of the test to 76%. The results remained accurate when validated in a small prospective cohort.ConclusionShortened ST segment in Lead II, lack of isoelectric ST segment, slurred QRS and ST/QT ratio <0.24 are predictive of underlying Brugada pattern in baseline ECG.

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“…The ECGs of patients with the Brugada type 1 pattern were also examined for features considered to be high risk for malignant arrhythmias, including QRS duration >120 ms in lead V2,10 corrected QT (QT C ) interval length >460 ms in lead V2,11 fragmented QRS,10 11 significant S wave (≥0.1 mV and/or ≥40 ms) in lead I,12 and the aVR sign (R wave ≥3 mm or R/q ratio ≥0.75 in lead aVR) 10 13…”

Section: Subjects and Methodsmentioning

confidence: 99%

Cardiac events occurred commonly among apparently healthy Filipinos with the Brugada ECG pattern in the LIFECARE cohort

Gervacio-Domingo

Aherrera

et al. 2018

Heart Asia

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A New Electrocardiographic Marker of Sudden Death in Brugada Syndrome

Cited by 137 publications

References 37 publications

Identification of electrocardiographic risk markers for the initial and recurrent episodes of ventricular fibrillation in patients with Brugada syndrome

Identification of electrocardiographic risk markers for the initial and recurrent episodes of ventricular fibrillation in patients with Brugada syndrome

Evaluation of baseline ECG in patients undergoing Oral Flecainide Challenge test for suspected Brugada Syndrome: An analysis of lead II

Cardiac events occurred commonly among apparently healthy Filipinos with the Brugada ECG pattern in the LIFECARE cohort

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