Inferior and lateral electrocardiographic repolarization abnormalities in Brugada syndrome.
BACKGROUND
Repolarization abnormalities in the inferior-lateral leads in Brugada syndrome (BS) have not been systematically investigated.


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 > or = 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.
Sarkozy
Andrea
A
Heart Rhythm Management Center, Universitair Ziekenhuis Brussels, Brussels, 1090-B, Belgium. andreasarkozy@yahoo.ca
Chierchia
Gian-Battista
GB
Paparella
Gaetano
G
Boussy
Tim
T
De Asmundis
Carlo
C
Roos
Marcus
M
Henkens
Stefan
S
Kaufman
Leonard
L
Buyl
Ronald
R
Brugada
Ramon
R
Brugada
Josep
J
Brugada
Pedro
P
D000328:Adult; D053840:Brugada Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D004562:Electrocardiography; D005190:Family; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012032:Refractory Period, Electrophysiological / Q000502:physiology*; D055815:Young Adult