Published Online
on February 13, 2009

A more recent version of this article appeared on April 1, 2009

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Original Article

Inferior and lateral electrocardiographic repolarization abnormalities in Brugada syndrome

Andrea Sarkozy^1,5; Gian-Battista Chierchia¹; Gaetano Paparella¹; Tim Boussy¹; Carlo De Asmundis¹; Markus Roos¹; Stefan Henkens¹; Leonard Kaufman²; Ronald Buyl²; Ramon Brugada³; Josep Brugada⁴ and Pedro Brugada¹

¹ UZ Brussel;
² Vrije Universiteit Brussel;
³ University of Girona;
⁴ University of Barcelona

⁵ E-mail: andreasarkozy{at}yahoo.ca

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

Methods and Results—280 patients (age: 41±18y, 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. 32 patients (11%) had inferior-lateral spontaneous Early Repolarization Pattern. These patients were less likely to be asymptomatic at first presentation (13 of 32 pts vs 156 of 248 pts, p=0.02) and spontaneous type I ECG was more frequent among them (38% vs. 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% vs 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 vs. 172±31 ms, p<0.001) and class I AAD induced QRS interval prolongation (108 to 178 ms vs 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: death, sudden (if surviving, use heart arrest) • electrocardiography • Brugada syndrome

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]