Clinical Presentation and Outcome of Brugada Syndrome Diagnosed With the New 2013 Criteria.
The 2013 HRS/EHRA/APHRS consensus statement recommends the use of V1 and V2 leads recorded in the second and third intercostal spaces (High-ICS) for diagnosis of Brugada syndrome (BrS) creating a new category of patients discovered only with modified leads. The clinical presentation and the arrhythmic risk in these patients are ill defined. This study was aimed at assessing the role of High-ICS in the analysis of BrS and the clinical profile of the patients diagnosed only when ECG leads are moved to upper intercostal spaces.



We searched our Brugada syndrome registry and identified 300 subjects (age 36 ± 13 years), without a diagnostic coved ST-segment elevation in conventional V1 -V3 leads, both at baseline and after provocative drug challenge. Sixty-four subjects (21.3%, mean age at last follow-up 42 ± 11 years) were diagnosed with High-ICS. Diagnosis was possible at baseline only in 4 subjects while in 60 it was made after drug challenge with sodium channel blockers. Three subjects (4.7%) with spontaneous abnormal ECG experienced cardiac events with an annual event rate (0.11%) superimposable to that of the low risk category of BrS diagnosed in standard leads.



This study demonstrates that the use of new diagnostic criteria for BrS allows increasing the diagnostic yield by 20% and that the arrhythmic risk is low when BrS can be established only in High-ICS. We also show that the prognostic value of spontaneous ECG pattern is confirmed in this subgroup.
Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
Antonio
A
Curcio
Laboratory of Molecular Cardiology, IRCCS Salvatore Maugeri Foundation, Pavia, Italy.
Andrea
A
Mazzanti
Laboratory of Molecular Cardiology, IRCCS Salvatore Maugeri Foundation, Pavia, Italy.
Raffaella
R
Bloise
Laboratory of Molecular Cardiology, IRCCS Salvatore Maugeri Foundation, Pavia, Italy.
Nicola
N
Monteforte
Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.|U.R.T.-C.N.R, Catanzaro, Italy.
Ciro
C
Indolfi
Laboratory of Molecular Cardiology, IRCCS Salvatore Maugeri Foundation, Pavia, Italy.|Department of Molecular Medicine, University of Pavia, Pavia, Italy.
Silvia G
SG
Priori
Laboratory of Molecular Cardiology, IRCCS Salvatore Maugeri Foundation, Pavia, Italy.
Carlo
C
Napolitano
D000200:Action Potentials; D000328:Adult; D053840:Brugada Syndrome / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D004562:Electrocardiography / Q000592:standards; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D012042:Registries; D055815:Young Adult
Brugada syndrome; ST-segment elevation; antiarrhythmic drugs; genetics; risk stratification; sudden cardiac death