What does this research mean for the field?

Electrocardiographic markers of right ventricular outflow tract (RVOT) conduction delay, specifically the aVR sign and a large S wave in lead I, significantly predict an increased risk of major arrhythmic events in patients with Brugada Syndrome. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 17, 2022Open Access

Electrocardiographic Markers Indicating Right Ventricular Outflow Tract Conduction Delay as a Predictor of Major Arrhythmic Events in Patients With Brugada Syndrome: A Systematic Review and Meta-Analysis

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Brugada Syndrome (n=2575). Intervention: RVOT conduction delay sign (aVR sign and large S wave in lead I) vs. Absence of RVOT conduction delay sign. Primary outcome: Major arrhythmic events (syncope, VT, VF, SCD, aborted SCD, appropriate ICD shocks) (RR 1.87, 95% CI 1.35-2.58, p=<0.001).

MIMohammad IqbalSepuluh Nopember Institute of Technology IPIwan Cahyo Santosa PutraElectrophysiology RPRaymond PranataElectrophysiology

Key Result

RVOT conduction delay sign on ECG, presented by aVR sign and large S wave in lead I, significantly increased the risk of major arrhythmic events in patients with Brugada syndrome (RR 1.87).

Study Design

Type

Meta-Analysis (n=2,575)

Structured PICO

Do RVOT conduction delay signs on ECG predict major arrhythmic events in patients with Brugada Syndrome?

Population

2,575 participants with Brugada Syndrome from 11 cohort studies

Intervention

Presence of RVOT conduction delay signs on ECG (aVR sign and large S wave in lead I)

Comparator

Absence of RVOT conduction delay signs on ECG

Outcome

Major arrhythmic events (MAE) related to BrS (syncope/VT/VF/SCD/aborted SCD/appropriate ICD shocks)composite

RVOT conduction delay signs on ECG (aVR sign and large S wave in lead I) are significant predictors of major arrhythmic events in patients with Brugada Syndrome and may be useful for risk stratification.

Main Result

Effect estimate: RR 1.87 (95% CI 1.35-2.58)

p-value: p=<0.001

Limitations

Most included studies were retrospective designs, increasing the risk of recall and selection bias.
Several confounding factors, including ECG pattern of spontaneous type I Brugada, prior syncope, family history of SCD, presence of SCN5A gene mutation, and inducible VTA in EPS, were not adjusted in most included studies.
High heterogeneity was noted in a sub-group analysis of large S wave in the lead I.
Lack of studies investigating the impact of ECG parameters indicating RVOT conduction delay sign on MAE in BrS patients according to patients' age and clinical presentation.

Abstract

Introduction Risk stratification in Brugada Syndrome (BrS) patients is still challenging due to the heterogeneity of clinical presentation; thus, some additional risk markers are needed. Several studies investigating the association between RVOT conduction delay sign on electrocardiography (ECG) and major arrhythmic events (MAE) in BrS patients showed inconclusive results. This meta-analysis aims to evaluate the association between RVOT conduction delay signs presented by aVR sign and large S wave in lead I, and MAE in BrS patients. Methods The literature search was performed using several online databases from the inception to March 16 th , 2022. We included studies consisting of two main components, including ECG markers of RVOT conduction delay (aVR sign and large S wave in lead I) and MAE related to BrS (syncope/VT/VF/SCD/aborted SCD/appropriate ICD shocks) Results Meta-analysis of eleven cohort studies with a total of 2,575 participants showed RVOT conduction delay sign was significantly associated with MAE in BrS patients RR = 1.87 (1.35, 2.58); p 0.001; I 2 = 52%, P heterogeneity = 0.02. Subgroup analysis showed that aVR sign RR = 2.00 (1.42, 2.83); p 0.001; I 2 = 0%, P heterogeneity = 0.40 and large S wave in lead I RR = 1.74 (1.11, 2.71); p = 0.01; I 2 = 60%, P heterogeneity = 0.01 were significantly associated with MAE. Summary receiver operating characteristics analysis revealed the aVR sign AUC: 0.77 (0.73–0.80) and large S wave in lead I AUC: 0.69 (0.65–0.73) were a good predictor of MAE in BrS patients. Conclusion RVOT conduction delay sign, presented by aVR sign and large S wave in the lead I, is significantly associated with an increased risk of MAE in BrS patients. Hence, we propose that these parameters may be useful as an additional risk stratification tool to predict MAE in BrS patients. Systematic Review Registration https://www.crd.york.ac.uk/prospero/#recordDetails , identifier: CRD42022321090.

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Cite This Study

Iqbal et al. (Fri,) conducted a meta-analysis in Brugada Syndrome (n=2,575). RVOT conduction delay sign (aVR sign and large S wave in lead I) vs. Absence of RVOT conduction delay sign was evaluated on Major arrhythmic events (syncope, VT, VF, SCD, aborted SCD, appropriate ICD shocks) (RR 1.87, 95% CI 1.35-2.58, p=<0.001). RVOT conduction delay sign on ECG, presented by aVR sign and large S wave in lead I, significantly increased the risk of major arrhythmic events in patients with Brugada syndrome (RR 1.87).

synapsesocial.com/papers/6a0cfb5632f3c40b5ccbafed https://doi.org/https://doi.org/10.3389/fcvm.2022.931622

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