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.
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Bebiano Da Providencia E Costa_ECG Non Type-1 Brugada pattern criteria in SCD-SOS cohort.pdf Access restricted to UCL open access staff until 17 July 2023. Download (785kB) |
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.
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