Arrhythmias and conduction disturbance
Diagnostic and Prognostic Value of a Type 1 Brugada Electrocardiogram at Higher (Third or Second) V1 to V2 Recording in Men With Brugada Syndrome

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To evaluate the diagnostic and prognostic value of an electrocardiogram (ECG) recorded at a higher (third or second) intercostal space, 98 men (17 to 76 years of age, mean ± SD 47 ± 13; with documented ventricular fibrillation [VF] in 22 and syncope in 32) were categorized into 3 groups; 68 men had a spontaneous type 1 ECG in standard leads V1 and V2 (S group), 19 had a spontaneous type 1 ECG only in the higher V1 and V2 leads (H group), and 11 had a type 1 ECG only after receiving class Ic sodium channel blockers (Ic group). There were no significant differences in baseline clinical characteristics, including VF episodes, syncope, atrial fibrillation, family history, late potentials, and inducibility of VF during electrophysiologic study across the 3 groups. During prospective follow-up periods (779 ± 525, 442 ± 282, and 573 ± 382 days, respectively), subsequent cardiac events occurred in 11 men (16%) within the S group, in 2 men (11%) in the H group, and in 0 men (0%) in the Ic group (p = NS, S vs H group). In men with previous episodes of VF, subsequent cardiac events occurred in 7 (44%) within the S group and in 2 (50%) in the H group (p = NS). In conclusion, men with a spontaneous type 1 Brugada ECG recorded only at higher leads V1 and V2 showed a prognosis similar to that of men with a type 1 ECG in using standard leads V1 and V2.

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Methods

The study population consisted of 98 probands from 98 unrelated families in whom a type 1 Brugada ECG was documented in leads V1 and V2 at a standard (fourth) and/or higher (third or second) intercostal space in the absence or presence of class Ic sodium channel blockers. They were enrolled between October 2000 and September 2004 and were followed prospectively. All 98 patients were men. Their average age at enrollment was 47 ± 13 years (17 to 76). VF had been documented in 22 men and 32 had

Results

Table 1 presents a comparison of clinical, electrocardiographic, and electrophysiologic characteristics across the S group (spontaneous only), H group (spontaneous only), and Ic group. There were no significant differences in baseline clinical characteristics with respect to gender, age, frequency of documented episodes of VF and syncope, family history (sudden cardiac death or a Brugada ECG), late potential, atrial fibrillation, and inducibility of VF/ventricular tachycardia during the

Discussion

The major findings of our study were that (1) recording at a higher space in leads V1 and V2 had higher sensitivity than that at a standard space in these leads in detecting a type 1 Brugada ECG and (2) a type 1 Brugada ECG recorded only at a higher space in leads V1 and V2 showed a similar prognostic value for subsequent cardiac events as that recorded at a standard space in these leads.

Priori et al9 reported that only 50% of patients with Brugada syndrome in whom repetitive baseline ECGs were

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Dr. Shimizu was supported by the Hoansha Research Foundation, Japan Research Foundation for Clinical Pharmacology, Ministry of Education, Culture, Sports, Science and Technology Leading Project for Biosimulation, and Health Sciences Research Grants (H18, Research on Human Genome, 002) from the Ministry of Health, Labour and Welfare, Tokyo, Japan.

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