Guillem Serra1, Adrián Baranchuk2, Antoni Bayés-De-Luna3, Josep Brugada4, Diego Goldwasser1, Lucio Capulzini5, David Arazo1, Araceli Boraita6, Maria-Eugenia Heras6, Javier Garcia-Niebla7, Roberto Elosua8, Ramón Brugada9, Pedro Brugada10. 1. Hospital de la Santa Creu i Sant Pau, Cardiovascular Research Center, CSIC-ICCC, S. Antoni M. Claret 167, 08025 Barcelona, Spain. 2. Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, ON, Canada. 3. Hospital de la Santa Creu i Sant Pau, Cardiovascular Research Center, CSIC-ICCC, S. Antoni M. Claret 167, 08025 Barcelona, Spain abayes@csic-iccc.org. 4. Cardiology Department, Hospital Clinic, Thorax Institute, Barcelona, Spain. 5. University Hospital (UZ) Brussels, Brussels, Belgium Cardiology Department, Sant'Andrea Hospital, La Spezia, Italy. 6. Consejo Superior de Deportes, Madrid, Spain. 7. Servicio Canario de Salud, El Hierro, Spain. 8. IMIM, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain. 9. University of Girona, Girona, Spain. 10. University Hospital (UZ) Brussels, Brussels, Belgium.
Abstract
AIMS: Diagnosis of Type-2 Brugada pattern remains challenging and it could be confused with other electrocardiogram (ECG) patterns presenting an r'-wave in leads V1-V2 like in healthy athletes. This could impact their ability to perform competitive sports. The aim of the study was to evaluate, as a proof of concept, the new ECG criteria to differentiate the Type-2 Brugada pattern from the ECG pattern of healthy athletes depicting an r'-wave in leads V1-V2. METHODS AND RESULTS: Surface ECGs from 50 patients with Brugada syndrome and type-2 Brugada pattern and 58 healthy athletes with an r'-wave in leads V1-V2 were analysed. Different criteria based on the characteristics of the triangle formed by the ascendant and descendant arms of the r'-wave in leads V1-V2 were compared. The duration of the base of the triangle at 0.5 mV (5 mm) from high take-off ≥160 ms (4 mm) has a specificity (SP) of 95.6%, sensitivity (SE) 85%, positive predictive value (PPV) 94.4%, and negative predictive value (NPV) 87.9%. The duration of the base of the triangle at the isoelectric line ≥60 ms (1.5 mm) in leads V1-V2 has an SP of 78%, SE 94.8%, PPV 79.3%, and NPV 93.5%. The ratio of the base at isoelectric line/height from the baseline to peak of r'-wave in leads V1-V2 has an SP of 92.1%, SE 82%, PPV 90.1%, and NPV 83.3%. CONCLUSIONS: The three new ECG criteria were accurate to distinguish the Type-2 Brugada pattern from the ECG pattern with an r'-wave in healthy athletes. The duration of the base of the triangle at 0.5 mV from the high take-off is the easiest to measure and may be used in clinical practice. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Diagnosis of Type-2 Brugada pattern remains challenging and it could be confused with other electrocardiogram (ECG) patterns presenting an r'-wave in leads V1-V2 like in healthy athletes. This could impact their ability to perform competitive sports. The aim of the study was to evaluate, as a proof of concept, the new ECG criteria to differentiate the Type-2 Brugada pattern from the ECG pattern of healthy athletes depicting an r'-wave in leads V1-V2. METHODS AND RESULTS: Surface ECGs from 50 patients with Brugada syndrome and type-2 Brugada pattern and 58 healthy athletes with an r'-wave in leads V1-V2 were analysed. Different criteria based on the characteristics of the triangle formed by the ascendant and descendant arms of the r'-wave in leads V1-V2 were compared. The duration of the base of the triangle at 0.5 mV (5 mm) from high take-off ≥160 ms (4 mm) has a specificity (SP) of 95.6%, sensitivity (SE) 85%, positive predictive value (PPV) 94.4%, and negative predictive value (NPV) 87.9%. The duration of the base of the triangle at the isoelectric line ≥60 ms (1.5 mm) in leads V1-V2 has an SP of 78%, SE 94.8%, PPV 79.3%, and NPV 93.5%. The ratio of the base at isoelectric line/height from the baseline to peak of r'-wave in leads V1-V2 has an SP of 92.1%, SE 82%, PPV 90.1%, and NPV 83.3%. CONCLUSIONS: The three new ECG criteria were accurate to distinguish the Type-2 Brugada pattern from the ECG pattern with an r'-wave in healthy athletes. The duration of the base of the triangle at 0.5 mV from the high take-off is the easiest to measure and may be used in clinical practice. Published on behalf of the European Society of Cardiology. All rights reserved.
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