Why the study?
Patients with Brugada syndrome are at increased risk of life-threatening ventricular arrhythmias, but automated ECG measurements had not been tested for predicting adverse outcomes.
Does automated ECG analysis predict spontaneous ventricular tachycardia or ventricular fibrillation in patients with Brugada syndrome?
Does automated ECG analysis predict spontaneous ventricular tachycardia or ventricular fibrillation in patients with Brugada syndrome?
Automated ECG analysis can extract novel depolarization and repolarization markers, such as ST slope, to effectively predict life-threatening ventricular arrhythmias in patients with Brugada syndrome.
May aid VT/VF risk stratification in Brugada syndrome; hypothesis-generating and requires prospective validation.
Background: Patients suffering from Brugada syndrome (BrS) are at an increased risk of life-threatening ventricular arrhythmias. Whilst electrocardiographic (ECG) variables have been used for risk stratification with varying degrees of success, automated measurements have not been tested for their ability to predict adverse outcomes in BrS. Methods: BrS patients presenting in a single tertiary center between 2000 and 2018 were analyzed retrospectively. ECG variables on vector magnitude, axis, amplitude and duration from all 12 leads were determined. The primary endpoint was spontaneous ventricular tachycardia/ventricular fibrillation (VT/VF) on follow-up. Results: This study included 83 patients [93% male, median presenting age: 56 (41–66) years old, 45% type 1 pattern] with 12 developing the primary endpoint (median follow-up: 75 (Q1–Q3: 26–114 months). Cox regression showed that QRS frontal axis > 70.0 degrees, QRS horizontal axis > 57.5 degrees, R-wave amplitude (lead I) <0.67 mV, R-wave duration (lead III) > 50.0 ms, S-wave amplitude (lead I) < −0.144 mV, S-wave duration (lead aVL) > 35.5 ms, QRS duration (lead V3) > 96.5 ms, QRS area in lead I < 0.75 Ashman units, ST slope (lead I) > 31.5 deg, T-wave area (lead V1) < −3.05 Ashman units and PR interval (lead V2) > 157 ms were significant predictors. A weighted score based on dichotomized values provided good predictive performance (hazard ratio: 1.59, 95% confidence interval: 1.27–2.00, P -value<0.0001, area under the curve: 0.84). Conclusions: Automated ECG analysis revealed novel risk markers in BrS. These markers should be validated in larger prospective studies.
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Tse et al. (2021) studied this question.
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