title: New electrocardiographic criteria to differentiate the Type-2 Brugada pattern from electrocardiogram of healthy athletes with r'-wave in leads V1/V2.
abstract: OBJECTIVE
  Diagnosis of Type-2 Brugada pattern remains challenging and it could be confused with other electrocardiogram (ECG) patterns presenting an r'-wave in leads V1-V2 like in healthy athletes. This could impact their ability to perform competitive sports. The aim of the study was to evaluate, as a proof of concept, the new ECG criteria to differentiate the Type-2 Brugada pattern from the ECG pattern of healthy athletes depicting an r'-wave in leads V1-V2.
  
  
  RESULTS
  Surface ECGs from 50 patients with Brugada syndrome and type-2 Brugada pattern and 58 healthy athletes with an r'-wave in leads V1-V2 were analysed. Different criteria based on the characteristics of the triangle formed by the ascendant and descendant arms of the r'-wave in leads V1-V2 were compared. The duration of the base of the triangle at 0.5 mV (5 mm) from high take-off ≥160 ms (4 mm) has a specificity (SP) of 95.6%, sensitivity (SE) 85%, positive predictive value (PPV) 94.4%, and negative predictive value (NPV) 87.9%. The duration of the base of the triangle at the isoelectric line ≥60 ms (1.5 mm) in leads V1-V2 has an SP of 78%, SE 94.8%, PPV 79.3%, and NPV 93.5%. The ratio of the base at isoelectric line/height from the baseline to peak of r'-wave in leads V1-V2 has an SP of 92.1%, SE 82%, PPV 90.1%, and NPV 83.3%.
  
  
  CONCLUSIONS
  The three new ECG criteria were accurate to distinguish the Type-2 Brugada pattern from the ECG pattern with an r'-wave in healthy athletes. The duration of the base of the triangle at 0.5 mV from the high take-off is the easiest to measure and may be used in clinical practice.
authors.affiliation: Hospital de la Santa Creu i Sant Pau, Cardiovascular Research Center, CSIC-ICCC, S. Antoni M. Claret 167, 08025 Barcelona, Spain.
authors.forename: Guillem
authors.initials: G
authors.lastname: Serra
authors.affiliation: Heart Rhythm Service, Kingston General Hospital, Queen's University, Kingston, ON, Canada.
authors.forename: Adrián
authors.initials: A
authors.lastname: Baranchuk
authors.affiliation: Hospital de la Santa Creu i Sant Pau, Cardiovascular Research Center, CSIC-ICCC, S. Antoni M. Claret 167, 08025 Barcelona, Spain abayes@csic-iccc.org.
authors.forename: Antoni
authors.initials: A
authors.lastname: Bayés-De-Luna
authors.affiliation: Cardiology Department, Hospital Clinic, Thorax Institute, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
authors.affiliation: Hospital de la Santa Creu i Sant Pau, Cardiovascular Research Center, CSIC-ICCC, S. Antoni M. Claret 167, 08025 Barcelona, Spain.
authors.forename: Diego
authors.initials: D
authors.lastname: Goldwasser
authors.affiliation: University Hospital (UZ) Brussels, Brussels, Belgium Cardiology Department, Sant'Andrea Hospital, La Spezia, Italy.
authors.forename: Lucio
authors.initials: L
authors.lastname: Capulzini
authors.affiliation: Hospital de la Santa Creu i Sant Pau, Cardiovascular Research Center, CSIC-ICCC, S. Antoni M. Claret 167, 08025 Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Arazo
authors.affiliation: Consejo Superior de Deportes, Madrid, Spain.
authors.forename: Araceli
authors.initials: A
authors.lastname: Boraita
authors.affiliation: Consejo Superior de Deportes, Madrid, Spain.
authors.forename: Maria-Eugenia
authors.initials: ME
authors.lastname: Heras
authors.affiliation: Servicio Canario de Salud, El Hierro, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Garcia-Niebla
authors.affiliation: IMIM, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: Elosua
authors.affiliation: University of Girona, Girona, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: Brugada
authors.affiliation: University Hospital (UZ) Brussels, Brussels, Belgium.
authors.forename: Pedro
authors.initials: P
authors.lastname: Brugada
mesh_terms: D000200:Action Potentials; D000293:Adolescent; D000328:Adult; D056352:Athletes; D053840:Brugada Syndrome / Q000175:diagnosis* / Q000503:physiopathology; D059267:Cardiomegaly, Exercise-Induced; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D064368:Healthy Volunteers; D006329:Heart Conduction System / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: Brugada ECG pattern; electrocardiogram; r′-wave ECG pattern