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Original Articles

Inferior and Lateral Electrocardiographic Repolarization Abnormalities in Brugada Syndrome

Andrea Sarkozy, MD; Gian-Battista Chierchia, MD; Gaetano Paparella, MD; Tim Boussy, MD; Carlo De Asmundis, MD; Marcus Roos, MD; Stefan Henkens, RN; Leonard Kaufman, PhD; Ronald Buyl, MSc; Ramon Brugada, MD, PhD; Josep Brugada, MD, PhD and Pedro Brugada, MD, PhD

From the Heart Rhythm Management Center (A.S., G.-B.C., G.P., T.B., C.D.A., M.R., S.H., P.B.), Universitair Ziekenhuis Brussels, Brussels, Belgium; the Department of Biostatistics and Medical Informatics (L.K., R.B.), Vrije Universiteit Brussel, Brussels, Belgium; the Cardiovascular Genetics Center (R.B.), University of Girona, Girona, Spain; and the Cardiology Department (J.B.), Thorax Institute, University of Barcelona, Barcelona, Spain.

Correspondence to Andrea Sarkozy, MD, Heart Rhythm Management Center, UZ Brussel–VUB, Laarbeeklaan 101, Brussels, 1090-B, Belgium. E-mail andreasarkozy{at}yahoo.ca or andrea.sarkozy@uzbrussel.be

Received May 30, 2008; accepted November 10, 2008.

Background— Repolarization abnormalities in the inferior-lateral leads in Brugada syndrome (BS) have not been systematically investigated.

Methods and Results— 280 patients (age, 41±18 years; 168 males) with BS were screened for inferior-lateral repolarization abnormalities. The repolarization abnormalities were classified either as early repolarization pattern or coved 2-mm Brugada pattern and as spontaneous or class I antiarrhythmic drug (AAD) induced. Thirty-two patients (11%) had inferior-lateral spontaneous early repolarization pattern. These patients were less likely to be asymptomatic at first presentation (13 of 32 versus 156 of 248 patients, P=0.02), and spontaneous type I ECG was more frequent among them (38% versus 21%, P=0.05). The spontaneous early repolarization pattern occurred more frequently among patients with BS than in 283 family members not having BS (11% versus 6%, P=0.03). Class I AAD administration provoked inferior-lateral coved Brugada pattern in 13 patients with BS. These patients had longer baseline PR intervals (206±48 versus 172±31 ms, P<0.001) and class I AAD–induced QRS interval prolongation (108 to 178 versus 102 ms to 131 ms, P<0.001). In 3 patients, the class I AAD–provoked coved Brugada pattern was only present in the inferior leads.

Conclusions— Inferior-lateral early repolarization pattern occurs spontaneously relatively frequently in BS. These patients have a more severe phenotype. Class I AAD administration provokes inferior-lateral coved Brugada pattern in 4.6% of patients. We report for the first time 3 patients in whom the class I AAD–provoked coved Brugada pattern was only observed in the inferior leads.

Key Words: electrocardiography • death, sudden • Brugada syndrome

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Related Article

Inferior and Lateral Electrocardiographic Repolarization Abnormalities in Brugada Syndrome

Andrea Sarkozy, Gian-Battista Chierchia, Gaetano Paparella, Tim Boussy, Carlo De Asmundis, Marcus Roos, Stefan Henkens, Leonard Kaufman, Ronald Buyl, Ramon Brugada, Josep Brugada, and Pedro Brugada
Circ Arrhythm Electrophysiol 2009 2: 154-161. [Abstract] [Full Text] [PDF]