Utility of high and standard right precordial leads during ajmaline testing for the diagnosis of Brugada syndrome.
OBJECTIVE
The authors sought to assess the value of the high right precordial leads (RPL) to detect the Type I Brugada ECG pattern in patients suspected of carrying Brugada syndrome (BrS).


METHODS
Ajmaline testing using 15-lead ECGs was performed in 183 patients suspected of carrying BrS. Standard 12-lead ECG with V1-V3 recorded from the fourth intercostal space and an additional three leads placed over V1-V3 recorded from the third intercostal space were analysed. ECGs were analysed for a Type I ECG pattern in either the standard or high RPLs.


RESULTS
Of the 183 tests, 31 (17%) were positive, and 152 were negative. In all positive studies, at least one high RPL became positive. In 13/31 (42%) cases, the Type I ECG pattern could be observed only in the high RPLs. Standard or high V3 were never positive before standard or high V1-V2. In seven patients, a Type I pattern was seen in one standard and one high RPL (vertical relationship).


CONCLUSIONS
The high RPLs are more sensitive than the conventional 12-lead ECG alone and initial observations suggest that they remain specific for BrS, while standard and high lead V3 offer redundant data. A vertical relationship of type 1 patterns may have a similar diagnostic value to that of a horizontal pair.
Division of Cardiac and Vascular Sciences, St George's University of London, Cranmer Terrace, London, UK. m.govindan@sgul.ac.uk
Malini
M
Govindan
Velislav N
VN
Batchvarov
Hariharan
H
Raju
Nesan
N
Shanmugam
Mukhtar
M
Bizrah
Rachael
R
Bastiaenen
Anatoli
A
Kiotsekoglou
John
J
Camm
Elijah R
ER
Behr
D000328:Adult; D000404:Ajmaline; D000889:Anti-Arrhythmia Agents; D053840:Brugada Syndrome / Q000175:diagnosis*; D016022:Case-Control Studies; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
D000889:Anti-Arrhythmia Agents; D000404:Ajmaline