A new high precordial leads treadmill exercise testing protocol increased the detection of type 1 Brugada ECG pattern compared to resting ECG alone (52.7% vs. 20.3%, P=0.001).
Cohort (n=74)
Does a new HPL-treadmill exercise testing protocol improve the detection of type 1 Brugada ECG pattern compared to resting HPL-ECG in patients with Brugada syndrome?
A novel treadmill exercise testing protocol using high precordial leads and a supine passive recovery phase significantly increases the diagnostic yield of type 1 Brugada ECG pattern compared to resting ECG.
Absolute Event Rate: 52.7% vs 20.3%
p-value: p=0.001
AIMS: High precordial leads (HPL) on the resting electrocardiogram (ECG) are widely used to improve diagnostic detection of type 1 Brugada ECG pattern (Br1ECGp). A parasympathetic activation marks the initial recovery phase of treadmill stress testing (TET), and this can be useful for detecting the typical ECG pattern. Our study aimed to evaluate the role of a new HPL-treadmill exercise testing (TET) protocol in detecting Br1ECGp fluctuation compared to resting HPL-ECG. METHODS AND RESULTS: 74 out of 163 patients of a Brugada syndrome (BrS) Brazilian cohort (GenBra Registry) underwent exercise testing with HPL-TET protocol. Precordial leads were displayed in strategic positions in the right and left parasternal spaces. The step-by-step analysis included ECG classification (as presence or absence of Br1ECGp) in standard vs. HPL leads placement in the following sequences: resting phase, maximal exercise, and the passive recovery phase (including 'quick lay down'). For heart rate recovery (HRR) measurements and comparisons, a Student's t-test was applied. McNemar tests compared the detection of Br1ECGp. The significance level was defined as P < 0.05. Fifty-seven patients (57/74; 77%) were male, the mean age was 49.0 ± 14, 78.4% had spontaneous BrS, and the mean Shanghai score was 4.5. The HPL-TET protocol increased Br1ECGp detection by 32.4% against resting HPL-ECG (52.7% vs. 20.3%, P = 0.001) alone. CONCLUSION: Stress testing using HPL with the passive recovery phase in the supine position offers an opportunity to unmask the type 1 Br1ECGp, which could increase the diagnostic yield in this population.
Pichara et al. (Sat,) conducted a cohort in Brugada syndrome (n=74). High precordial leads (HPL) treadmill exercise testing (TET) protocol vs. Resting HPL-ECG was evaluated on Detection of type 1 Brugada ECG pattern (Br1ECGp) (p=0.001). A new high precordial leads treadmill exercise testing protocol increased the detection of type 1 Brugada ECG pattern compared to resting ECG alone (52.7% vs. 20.3%, P=0.001).