title: Prevalence, characteristics, and prognosis role of type 1 ST elevation in the peripheral ECG leads in patients with Brugada syndrome.
abstract: BACKGROUND
  Despite isolated reports of Brugada syndrome (BrS) in the inferior or lateral leads, the prevalence and prognostic value of ST elevation in the peripheral electrocardiographic (ECG) leads in patients with BrS remain poorly known.
  
  
  OBJECTIVE
  To study the prevalence, characteristics, and prognostic value of type 1 ST elevation and ST depression in the peripheral ECG leads in a large cohort of patients with BrS.
  
  
  METHODS
  ECGs from 323 patients with BrS (age 47 ± 13 years; 257 men) with spontaneous (n = 141) or drug-induced (n = 182) type 1 ECG were retrospectively reviewed. Two hundred twenty-five (70%) patients were asymptomatic, 72 (22%) patients presented with unexplained syncope, and 26 (8%) patients presented with sudden death (12 patients) or appropriated implantable cardioverter-defibrillator therapies (14 patients) at diagnosis or over a mean follow-up of 48 ± 34 months.
  
  
  RESULTS
  Thirty (9%) patients presented with type 1 ST elevation in at least 1 peripheral lead (22 patients in the aVR leads, 2 in the inferior leads, 5 in both aVR and inferior leads, and 1 in the aVR and VL leads). Patients with type 1 ST elevation in the peripheral leads more often had mutations in the SCN5A gene, were more often inducible, had slower heart rate, and higher J-wave amplitude in the right precordial leads. Twenty-seven percent (8 of 30) of the patients with type 1 ST elevation in the peripheral leads experimented sudden death/appropriate implantable cardioverter-defibrillator therapy, whereas it occurred in only 6% (18 of 293) of other patients (P < .0001). In multivariate analysis, type 1 ECG in the peripheral leads was independently associated with malignant arrhythmic events (odds ratio 4.58; 95% confidence interval 1.7-12.32; P = .0025).
  
  
  CONCLUSIONS
  Type 1 ST elevation in the peripheral ECG leads can be seen in 10% of the patients with BrS and is an independent predictor for a malignant arrhythmic event.
authors.affiliation: University Hospital Rangueil, Toulouse, France.
authors.forename: A
authors.initials: A
authors.lastname: Rollin
authors.forename: F
authors.initials: F
authors.lastname: Sacher
authors.forename: J B
authors.initials: JB
authors.lastname: Gourraud
authors.forename: J L
authors.initials: JL
authors.lastname: Pasquié
authors.forename: F
authors.initials: F
authors.lastname: Raczka
authors.forename: A
authors.initials: A
authors.lastname: Duparc
authors.forename: P
authors.initials: P
authors.lastname: Mondoly
authors.forename: C
authors.initials: C
authors.lastname: Cardin
authors.forename: M
authors.initials: M
authors.lastname: Delay
authors.forename: S
authors.initials: S
authors.lastname: Chatel
authors.forename: N
authors.initials: N
authors.lastname: Derval
authors.forename: A
authors.initials: A
authors.lastname: Denis
authors.forename: M
authors.initials: M
authors.lastname: Sadron
authors.forename: J M
authors.initials: JM
authors.lastname: Davy
authors.forename: M
authors.initials: M
authors.lastname: Hocini
authors.forename: P
authors.initials: P
authors.lastname: Jaïs
authors.forename: L
authors.initials: L
authors.lastname: Jesel
authors.forename: M
authors.initials: M
authors.lastname: Haïssaguerre
authors.forename: V
authors.initials: V
authors.lastname: Probst
authors.forename: P
authors.initials: P
authors.lastname: Maury
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D053840:Brugada Syndrome / Q000401:mortality / Q000503:physiopathology*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D004562:Electrocardiography / Q000295:instrumentation*; D004566:Electrodes; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D055815:Young Adult