title: Usefulness of multichannel Holter ECG recording in the third intercostal space for detecting type 1 Brugada ECG: comparison with repeated 12-lead ECGs.
abstract: BACKGROUND
  Type 1 Brugada ECG is essential for the diagnosis of Brugada syndrome. We aimed to evaluate the usefulness of multichannel Holter ECG recording in the third intercostal space for detecting type 1 Brugada ECG.
  
  
  RESULTS
  We enrolled 60 consecutive individuals with type 1 Brugada ECG and 31 individuals with type 2 or 3 Brugada ECG, in the presence or absence of Na+ channel blockers. All individuals underwent 12-lead ECGs recorded in the standard position and the third intercostal space at least 5 times every 3 months (4L-ECGs, 3L-ECGs, respectively) and multichannel Holter ECG. On multichannel Holter ECG, the precordial electrodes were attached at standard positions (4L-Holter) and the third intercostal space (3L-Holter) for leads V1 and V2. Among the 60 individuals, type 1 Brugada ECG in 4L-ECGs, 3L-ECGs, 4L-Holter, and 3L-Holter was detected in 15 (25%), 26 (43.3%), 23 (38.3%), and 33 individuals (55%), respectively, whereas detected in none of the 31 individuals. The documented duration of type 1 Brugada ECG on 3L-Holter was significantly longer than that on 4L-Holter (700 +/- 467 vs 372 +/- 422 min; P = 0.01, 3L-Holter vs 4L-Holter, respectively), and type 1 Brugada ECG was most frequently observed between 6 pm and 12 pm. Neither the presence nor the duration of the appearance of type 1 Brugada ECG differed significantly between symptomatic and asymptomatic individuals.
  
  
  CONCLUSIONS
  Multichannel Holter ECG recording in the third intercostal space is more sensitive and useful for the diagnosis of type 1 Brugada ECG than repeated 12-lead ECGs or multichannel Holter ECG in the standard position.
authors.affiliation: Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Shimeno
authors.forename: Masahiko
authors.initials: M
authors.lastname: Takagi
authors.forename: Keiko
authors.initials: K
authors.lastname: Maeda
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Tatsumi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Doi
authors.forename: Minoru
authors.initials: M
authors.lastname: Yoshiyama
mesh_terms: D053840:Brugada Syndrome / Q000175:diagnosis*; D015716:Electrocardiography, Ambulatory / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D007366:Intercostal Muscles; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity