Key result
Brugada ECG pattern in ARVC linked to increased cardiac death and heart failure hospitalization.
Why the study?
Despite distinct pathophysiology, ARVC and Brugada syndrome exhibit overlapping phenotypes, prompting investigation into the prevalence and characteristics of the Brugada ECG pattern in ARVC patients.
Does the presence of a Brugada ECG pattern increase the risk of cardiac events in patients with arrhythmogenic right ventricular cardiomyopathy?
Cohort (n=114)
Does the presence of a Brugada ECG pattern increase the risk of cardiac events in patients with arrhythmogenic right ventricular cardiomyopathy?
The Brugada ECG pattern is rare and transient in ARVC patients but is associated with a significantly higher risk of cardiac death and heart failure hospitalization.
May support intensified monitoring in ARVC with Brugada pattern; leaves open need for prospective validation before practice change.
Background Despite distinct pathophysiology, arrhythmogenic right ventricular cardiomyopathy (ARVC) and Brugada syndrome (BrS) exhibit overlapping phenotypes. We investigated the prevalence and characteristics of the Brugada electrocardiogram (ECG) pattern in ARVC patients. Methods A total of 114 ARVC patients fulfilling the revised Task Force Criteria were enrolled. The Brugada ECG pattern was evaluated according to the consensus report on right precordial leads, and 1141 ECGs (median, 1; interquartile range, 1‐16 ECGs/patient) were analyzed. Results Five patients (4%) showed a Brugada ECG pattern, which disappeared in four patients with ECGs recorded more than 2 years afterward. ARVC patients with the Brugada ECG pattern had a longer PQ interval (220 ± 62 ms vs 180 ± 35 ms, P = .02) and longer QRS duration (138 ± 25 ms vs 102 ± 23 ms, P < .001) than patients without the pattern. During follow‐up (median, 11.4; interquartile range, 5.5‐17.1 years), 19 ARVC patients experienced cardiac death and 29 experienced heart failure (HF) hospitalization. Kaplan‐Meier analysis determined that the Brugada ECG pattern increased the risk of cardiac death and HF hospitalization (log‐rank; P < .001, P < .001 respectively). The mean J‐point and S‐wave amplitudes of the Brugada ECG pattern were 0.29 ± 0.05 mV and 0.34 ± 0.21 mV, respectively, which were significantly lower than those of 26 age‐matched BrS patients with a previous ventricular fibrillation episode (0.66 ± 0.33 mV, P < .001 and 0.67 ± 0.39 mV, P = .02 respectively). Conclusion The Brugada ECG pattern was infrequently encountered, was transient in ARVC patients, and was associated with a longer PQ interval, longer QRS duration, and cardiac events.
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Ueda et al. (2021) conducted a cohort in Arrhythmogenic right ventricular cardiomyopathy (n=114). Brugada ECG pattern vs. Without Brugada ECG pattern was evaluated on Cardiac death and heart failure hospitalization (p=<0.001). The Brugada ECG pattern was present in 4% of ARVC patients, was often transient, and was associated with an increased risk of cardiac death and heart failure hospitalization (P<0.001 for both).
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