Physical activity and Brugada ECG pattern during 12-lead Holter monitoring

BACKGROUND: Brugada Syndrome (BrS) is a hereditary channelopathy with a dynamic ECG pattern, often latent at rest. While several triggers can unmask the type 1 pattern, the influence of physical activity (PA) remains uncertain. This study investigated whether PA is associated with spontaneous type 1 ECG, its unmasking in induced cases, and the occurrence of arrhythmic events in Brugada athletes. METHODS: We enrolled 202 BrS patients (18-55 years), collecting demographic data, PA levels, resting ECG, and 12-lead Holter. Subjects exercising ≥4 hours/week were defined as "recreational athletes" per ESC guidelines. Statistical analyses included Mann-Whitney U, Chi-squared Tests, and logistic regression (adjusted for age/sex) to explore the relationship between PA and Brugada ECG patterns. RESULTS: Of 202 patients (155 males, median age 35.5), 48 were athletes. Athletes showed lower median heart rate at first Holter (71 vs. 75 bpm). No significant difference was found in Brugada pattern expression between groups. PA was not significantly associated with the presence of type 1 ECG (OR: 2.51, P=0.140). No arrhythmic events occurred during exercise or follow-up. CONCLUSIONS: PA does not increase Brugada ECG expression in spontaneous or induced cases. No arrhythmic events were reported in athletes during sport or follow-up.