The usefulness of the consensus clinical diagnostic criteria in Brugada syndrome.
BACKGROUND
Consensus statements were proposed for the diagnosis of Brugada syndrome (BS). The clinical diagnostic criteria were defined as documented ventricular fibrillation or ventricular tachycardia (VT), family history of sudden cardiac death at <45 years, diagnostic ECGs of family members, inducibility of VT during electrophysiological study, syncope or nocturnal agonal respiration. The clinical validation of these criteria is still missing. Methods and results 280 patients (41 ± 18 years, male: 168 pts) with diagnostic coved type I ECG were included. Consensus clinical diagnostic criteria were present in 244 (87%) patients (40 ± 18 y, 142 males). In 36 pts (13% of the 280 pts, 51 ± 12 years, 27 males) consensus clinical diagnostic criteria were not met. Nine patients (25%) presented with spontaneous type I ECG. Ten of the 36 patients (28%) had a history of atrial fibrillation and 13 (36%) had conduction disease on the baseline ECG. In 23 patients (64%) family screening was not performed. Two of the 36 patients had undocumented syncope during follow-up. Univariate analysis showed no significant difference in event free survival between patients with or without consensus clinical diagnostic criteria.


CONCLUSIONS
In a significant number of patients with diagnostic ECG pattern the current diagnostic criteria for BS are not met. These patients have frequently spontaneous type I ECG and clinical signs of Brugada syndrome as paroxysmal atrial fibrillation or conduction disturbances. Our results suggest that in patients with a diagnostic type I ECG pattern the current clinical consensus diagnostic criteria have limited added diagnostic value.
Heart Rhythm Management Center, UZ Brussels, Belgium. andreasarkozy@yahoo.ca
Andrea
A
Sarkozy
Gaetano
G
Paparella
Tim
T
Boussy
Ruben
R
Casado-Arroyo
Yoshinao
Y
Yazaki
Gian-Battista
GB
Chierchia
Carlo
C
De Asmundis
Fatih
F
Bayrak
Mehdi
M
Namdar
Sergio
S
Richter
Josep
J
Brugada
Pedro
P
Brugada
D000293:Adolescent; D000328:Adult; D053840:Brugada Syndrome / Q000175:diagnosis* / Q000503:physiopathology*; D032921:Consensus; D004562:Electrocardiography / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D055815:Young Adult