SMARTBrugada study: Smartwatch Marginosternal Application for Recording Type I Brugada pattern

Introduction Brugada Syndrome (BrS) is an inherited channelopathy increasing sudden cardiac death risk and diagnosed by a spontaneous Type I electrocardiographic pattern (≥ 2mm coved ST elevation associated with negative T-wave) in right precordial leads. This pattern is often dynamic and concealed on standard electrocardiogram (ECG) but may be unmasked using higher precordial leads (2nd/3rd intercostal spaces) or with prolonged ECG recordings. Objective The study aims to validate the use of Smartwatch for detecting spontaneous Type I Bugada Pattern using elevated precordial positions, quantify diagnostic performance versus standard ECGs via blinded expert interpretation and assess inter-rater reliability. Methods 25 patients with confirmed spontaneous Type I Brugada pattern (standard ECG or high leads only) and 65 healthy controls were enrolled. Each underwent: (1) Modified 12-lead ECG with high precordial leads and (2) Six sequential single self-recordings at the same precordial positions with a Smartwatch. Two blinded cardiologists independently assessed each recording for Type I Brugada pattern and identified the optimal Smartwatch lead position. Results interpretation of Smartwatch self-recordings demonstrated high diagnostic performance for Brugada pattern detection compared to ECG, with excellent specificity, overall accuracy, intra- and inter-rater agreement. Smartwatch recordings at the third intercostal space are significant for diagnosis in 82% of cases. Conclusion Smartwatch represents a useful tool to detect the presence of a type I Brugada pattern, with good diagnostic performance, especially when recordings were made at the 3rd intercostal space.