A notched P wave on a standard 12-lead ECG independently predicted life-threatening arrhythmias in patients with Brugada syndrome (HR 2.63; 95% CI 1.35-4.78; p=0.006).
Cohort (n=510)
Yes
Does the presence of a notched P wave on ECG predict life-threatening arrhythmias in patients with Brugada syndrome?
A notched P wave on a standard 12-lead ECG is an independent predictor of life-threatening arrhythmias in patients with Brugada syndrome, providing a simple tool to improve risk stratification.
Effect estimate: HR 2.63 (95% CI 1.35-4.78)
Absolute Event Rate: 27% vs 10%
p-value: p=0.006
BACKGROUND Risk stratification for ventricular fibrillation (VF) in Brugada syndrome (BrS) remains a major clinical challenge. Atrial fibrillation is relatively common in BrS, suggesting that atrial conduction abnormalities may be related to arrhythmogenesis. A notched P wave on the surface electrocardiogram (ECG) reflects atrial conduction delay, but its prognostic significance for VF in BrS has not been fully established. OBJECTIVE To evaluate the association between notched P waves and life-threatening arrhythmic events in patients with BrS. METHODS We analyzed 510 patients with BrS (mean age, 51 ± 14 years; 95% men) enrolled in a prospective multicenter registry across 61 hospitals in Japan. Clinical and ECG parameters at enrollment were assessed, and patients were followed for cardiac events (VF, sustained ventricular tachycardia, or sudden cardiac death). RESULTS During a mean follow-up of 107 ± 62 months, 58 patients (11%) experienced cardiac events. Notched P waves were present in 52 patients (10%). Patients with notched P waves had a significantly higher incidence of cardiac events compared with those without (27% vs. 10%, p < 0.001). Kaplan-Meier analysis demonstrated lower event-free survival in patients with notched P waves (p < 0.001). In multivariable Cox regression, a notched P wave remained an independent predictor of cardiac events (hazard ratio: 2.63; 95% CI: 1.35-4.78; p = 0.006), along with a history of VF. CONCLUSIONS A notched P wave on a standard 12-lead ECG independently predicts life-threatening arrhythmias in BrS and may improve risk stratification by complementing conventional predictors.
Shinohara et al. (Sun,) conducted a cohort in Brugada syndrome (n=510). Notched P wave vs. Without notched P wave was evaluated on Cardiac events (ventricular fibrillation, sustained ventricular tachycardia, or sudden cardiac death) (HR 2.63, 95% CI 1.35-4.78, p=0.006). A notched P wave on a standard 12-lead ECG independently predicted life-threatening arrhythmias in patients with Brugada syndrome (HR 2.63; 95% CI 1.35-4.78; p=0.006).