Key result
RVOT conduction delay on ECG linked to ~87% higher major arrhythmic risk in Brugada syndrome.
Why the study?
Risk stratification in Brugada Syndrome remains challenging, and prior studies evaluating the association between ECG markers of RVOT conduction delay and major arrhythmic events yielded inconclusive results.
Do RVOT conduction delay signs on ECG predict major arrhythmic events in patients with Brugada Syndrome?
Meta-Analysis (n=2,575)
Do RVOT conduction delay signs on ECG predict major arrhythmic events in patients with Brugada Syndrome?
Effect estimate: RR 1.87 (95% CI 1.35-2.58)
p-value: p=<0.001
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.
May aid ECG risk stratification in Brugada syndrome; extends prior inconclusive cohorts but needs prospective validation before practice change.
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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Iqbal et al. (2022) 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).