title: Insights into the location of type I ECG in patients with Brugada syndrome: correlation of ECG and cardiovascular magnetic resonance imaging.
abstract: BACKGROUND
  Brugada syndrome is characterized by ST-segment abnormalities in V1-V3. Electrocardiogram (ECG) leads placed in the 3rd and 2nd intercostal spaces (ICSs) increased the sensitivity for the detection of a type I ECG pattern. The anatomic explanation for this finding is pending.
  
  
  OBJECTIVE
  The purpose of the study was to correlate the location of the Brugada type I ECG with the anatomic location of the right ventricular outflow tract (RVOT).
  
  
  METHODS
  Twenty patients with positive ajmaline challenge and 10 patients with spontaneous Brugada type I ECG performed by using 12 right precordial leads underwent cardiovascular magnetic resonance imaging (CMRI). The craniocaudal and lateral extent of the RVOT and maximal RVOT area were determined. Type I ECG pattern and maximal ST-segment elevation were correlated to extent and maximal RVOT area, respectively.
  
  
  RESULTS
  In all patients, Brugada type I pattern was found in the 3rd ICS in sternal and left-parasternal positions. RVOT extent determined by using CMRI included the 3rd ICS in all patients. Maximal RVOT area was found in 3 patients in the 2nd ICS, in 5 patients in the 4th ICS, and in 22 patients in the 3rd ICS. CMRI predicted type I pattern with a sensitivity of 97.2%, specificity of 91.7%, positive predictive value of 88.6%, and negative predictive value of 98.0%. Maximal RVOT area coincided with maximal ST-segment elevation in 29 of 30 patients.
  
  
  CONCLUSIONS
  RVOT localization determined by using CMRI correlates highly with the type I Brugada pattern. Lead positioning according to RVOT location improves the diagnosis of Brugada syndrome.
authors: 1st Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany. christian.veltmann@umm.de
authors: C
authors: C
authors: Veltmann
authors: T
authors: T
authors: Papavassiliu
authors: T
authors: T
authors: Konrad
authors: C
authors: C
authors: Doesch
authors: J
authors: J
authors: Kuschyk
authors: F
authors: F
authors: Streitner
authors: D
authors: D
authors: Haghi
authors: H J
authors: HJ
authors: Michaely
authors: S O
authors: SO
authors: Schoenberg
authors: M
authors: M
authors: Borggrefe
authors: C
authors: C
authors: Wolpert
authors: R
authors: R
authors: Schimpf
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D053840:Brugada Syndrome / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D004562:Electrocardiography / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity