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Defining Electrocardiographic Criteria to differentiate Non-Type 1 Brugada ECG variants from normal incomplete RBBB patterns in the young SCD-SOS cohort

Carrington, Mafalda; Creta, Antonio; Young, William J; Carrington, Maria; Henriques, Jorge; Teixeira, Rogério; Gonçalves, Lino; ... Providência, Rui; + view all (2022) Defining Electrocardiographic Criteria to differentiate Non-Type 1 Brugada ECG variants from normal incomplete RBBB patterns in the young SCD-SOS cohort. Journal of Cardiovascular Electrophysiology , 33 (9) pp. 2083-2091. 10.1111/jce.15615. Green open access

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Abstract

INTRODUCTION: We assessed the prevalence of non-type 1 Brugada pattern (T1BrP) in children and young adults from the SCD-SOS cohort and the diagnostic yield of non-expert manual and automatic algorithm ECG measurements. METHODS: Cross-sectional study. We reviewed 14662 ECGs and identified 2226 with a rSr'-pattern in V1-V2. Among these, 115 were classified by experts in hereditary arrhythmic-syndromes as having or not non-T1BrP, and were compared with measurements of 5 ECG-derived parameters based on a triangle formed by r'-wave (d(A), d(B), d(B)/h, β-angle) and ST-ascent, assessed both automatically and manually by non-experts. We estimated intra and interobserver concordance for each criterion, calculated diagnostic accuracy and defined the most appropriate cut-off values. RESULTS: A rSr'-pattern in V1-V2 was associated with higher PQ interval and QRS duration, male gender and lower BMI. The manual measurements of non-T1BrP criteria were moderately reproducible with high intra-observer and moderate interobserver concordance coefficients (ICC:0.72-0.98, and 0.63-0.76). Criteria with higher discriminatory capacity were: distance d(B) (0.72;95%CI0.65-0.80) and ST-ascent (0.87;95%CI0.82-0.92), which was superior to the 4 r'-wave criteria together (AUC0.74). We suggest new cut-offs with improved combination of sensitivity and specificity: d(B)≥1.4mm and ST-ascent≥0.7mm (Sensitivity1-82%;Specificity71-84%), that can be automatically measured to allow classification in 4 morphologies with increasing non-T1BrP probability. CONCLUSION: rSr'-pattern in precordial leads V1-V2 is a frequent finding and the detection of non-T1BrP by using the aforementioned 5 measurements is reproducible and accurate. In this study, we describe new cut-off values that may help untrained clinicians to identify young individuals who may require further work-up for a potential Brugada Syndrome diagnosis. This article is protected by copyright. All rights reserved.

Type: Article
Title: Defining Electrocardiographic Criteria to differentiate Non-Type 1 Brugada ECG variants from normal incomplete RBBB patterns in the young SCD-SOS cohort
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/jce.15615
Publisher version: https://doi.org/10.1111/jce.15615
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Non-type 1 Brugada pattern, athlete's ECG, children and young adults, rSr’ pattern
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Clinical Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics
URI: https://discovery.ucl.ac.uk/id/eprint/10157263
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