Should all individuals with suspected arrhythmias but initially nondiagnostic electrocardiogram be ordered routinely higher intercostal space ECG?

Response to letter to the editor entitled “Should all individuals with a non‐diagnostic arrhythmic electrocardiogram be ordered routinely higher intercostal space electrocardiography?”

“…We thank Dr Ozeke and colleagues for their letter regarding our article and for sharing their experience regarding lowered sensitivity using the 12‐lead body surface electrocardiogram (ECG) in the conventional position to ascertain the Brugada syndrome (BrS) pattern . We concur with Ozeke and colleagues that additional leads in the higher intercostal (second and third) or high right ventricular (HRV) spaces increases the sensitivity for identifying the BrS pattern and should be used in the diagnostic work up for this condition …”

Ajmaline-induced Brugada Phenocopy, Right Bundle Branch Block, or Both?

“…In equivocal or suspected cases of BrS, ajmaline testing is frequently used in the diagnostic approach. 9 – 12 However, some authors have reported a potential 5% false-positive rate, thus making the universal interpretation of provocative drug testing challenging. 13 , 14 Therefore, not only diagnostic decisions but also therapeutic choices with long-term implications were adopted worldwide before the potential for false-positive results of the ajmaline test was fully appreciated.…”

The dividing line of arrhythmogenic right ventricular cardiomyopathy and Brugada syndrome at epicardial ablation era: Limited to or beyond RVOT?

“…Therefore, the presence of isolated subepicardial RVOT scar shares a broad differential diagnosis including BrS, cardiac sarcoidosis, exercise‐induced arrhythmogenic remodeling of athletes, ARVC/D, and post inflammatory cardiomyopathy . Although there is no clear dividing line between BrS and ARVC/D, it is believed that both are different clinical entities with respect to the clinical presentation and the genetic predisposition . Whereas the continuous administration of low‐dose isoproterenol may be effective for the suppression of repetitive ventricular arrhythmia occurrence in patients with BrS, the isoproterenol appears to have potential added diagnostic value in the setting of patients with suspected ARVC …”