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Clinical Presentation and Outcome of Brugada Syndrome Diagnosed With the New 2013 Criteria
Author(s) -
CURCIO ANTONIO,
MAZZANTI ANDREA,
BLOISE RAFFAELLA,
MONTEFORTE NICOLA,
INDOLFI CIRO,
PRIORI SILVIA G.,
NAPOLITANO CARLO
Publication year - 2016
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.12997
Subject(s) - medicine , brugada syndrome , cardiology , presentation (obstetrics) , sudden cardiac death , pediatrics , surgery
Brugada Syndrome in Modified Precordial Leads Introduction The 2013 HRS/EHRA/APHRS consensus statement recommends the use of V 1 and V 2 leads recorded in the second and third intercostal spaces (High‐ICS) for diagnosis of Brugada syndrome (BrS) creating a new category of patients discovered only with modified leads. The clinical presentation and the arrhythmic risk in these patients are ill defined. This study was aimed at assessing the role of High‐ICS in the analysis of BrS and the clinical profile of the patients diagnosed only when ECG leads are moved to upper intercostal spaces. Methods and Results We searched our Brugada syndrome registry and identified 300 subjects (age 36 ± 13 years), without a diagnostic coved ST‐segment elevation in conventional V 1 –V 3 leads, both at baseline and after provocative drug challenge. Sixty‐four subjects (21.3%, mean age at last follow‐up 42 ± 11 years) were diagnosed with High‐ICS. Diagnosis was possible at baseline only in 4 subjects while in 60 it was made after drug challenge with sodium channel blockers. Three subjects (4.7%) with spontaneous abnormal ECG experienced cardiac events with an annual event rate (0.11%) superimposable to that of the low risk category of BrS diagnosed in standard leads. Conclusion This study demonstrates that the use of new diagnostic criteria for BrS allows increasing the diagnostic yield by 20% and that the arrhythmic risk is low when BrS can be established only in High‐ICS. We also show that the prognostic value of spontaneous ECG pattern is confirmed in this subgroup.