Key result
Peripheral Type 1 Brugada pattern during ajmaline testing is linked to ~41 ms longer posttest QRS.
Why the study?
The incidence of Brugada-type ECG pattern in peripheral leads during ajmaline testing in patients suspected of Brugada syndrome was unknown.
Observational (n=143)
Absolute Event Rate: 175% vs 134%
p-value: p=<0.001
Atypical Brugada-type ECG changes in peripheral leads occur in approximately 10% of positive ajmaline tests and are associated with more pronounced baseline and post-test conduction delays.
Peripheral lead Type 1 patterns during ajmaline testing associate with greater QRS prolongation; leaves open prognostic implications for Brugada risk stratification.
BACKGROUND: Although cases of Brugada-type electrocardiographic (ECG) pattern in peripheral (limb) leads have been reported ("atypical" Brugada syndrome [BS]), their incidence in patients investigated for BS is unknown. METHODS: We retrospectively analyzed an ECG database collected during ajmaline test in 143 patients (89 men) with suspected BS. In 42 patients, 12-lead ECGs were recorded, whereas in 101 patients, leads V1-V3 from the third intercostal space were also recorded. The presence of types 1, 2, and 3 Brugada pattern in each limb and precordial lead was noted and the PR, QRS, and QTc intervals were calculated. RESULTS: There were 114 (79.7%) negative and 29 (20.3%) positive tests. Type 1 pattern developed in >or=1 limb lead in six patients (4.2%) (3/29 with positive tests, 10.3%); all of them were male, symptomatic, and/or with family history of BS or sudden cardiac death. Their pre- and posttest QRS were significantly longer compared with the rest with positive (n = 26) or negative (n = 111) test (pretest: 129 +/- 31 ms vs 101 +/- 11 ms and 97 +/- 12 ms, P < 0.001; posttest: 175 +/- 44 ms vs 134 +/- 14 ms and 131 +/- 19 ms, P < 0.001). The posttest QTc was longer in patients with peripheral changes compared with the rest (507 +/- 47 ms vs 453 +/- 22 ms and 447 +/- 24 ms, P < 0.001). The pretest QTc and pre- and posttest heart rate and PR intervals were not significantly different between the three groups. CONCLUSIONS: Type 1 Brugada pattern in the peripheral leads was observed in 4.2% of patients during ajmaline test (10.3% of positive tests) and was associated with longer QRS and greater QTc prolongation compared with the rest of the patients.
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Batchvarov et al. (2009) conducted an observational in Suspected Brugada syndrome (n=143). Type 1 Brugada pattern in peripheral leads vs. Patients without peripheral lead changes was evaluated on Posttest QRS duration (p=<0.001). Type 1 Brugada pattern in peripheral leads occurred in 4.2% of patients during ajmaline testing and was associated with significantly longer posttest QRS (175 vs 134 ms, P<0.001).
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