Abstract 14591: Where to Position ECG Leads to Detect the Brugada Phenotype? Correlation of ECG and Cardiovascular Magnetic Resonance Imaging
Background: Brugada syndrome is characterized by ST-segment abnormalities in V1-V3. ECG recording using leads V1 and V2 in the 3rd and 2nd intercostal space (ICS) increases the sensitivity for the detection of a type-I ECG. The anatomic explanation for this finding is pending. 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) using cardiovascular magnetic resonance imaging (CMR).
Methods: 30 patients with a Brugada type-I ECG (20 patients following ajmaline administration and 10 patients with spontaneous type-I ECG) underwent CMR. ECGs were recorded using 12 right precordial leads, positioned in the 2nd, 3rd, 4th and 5th ICS, in right-parasternal, sternal and left-parasternal position. By CMR, craniocaudal and lateral extent and the maximal RVOT area were determined. Type-I ECG pattern and maximal ST elevation were correlated to extent and maximal RVOT area, respectively.
Results: The highest sensitivity for a Brugada type-I pattern was found for the 4th and 3rd ICS in sternal position (93% and 89%, respectively). In all patients RVOT extent included the 3rd ICS (range 2nd to 5th ICS). Maximal RVOT area was found in 3 patient in the 2nd, in 5 patients in the 4th and in the majority (22 patients) in the 3rd ICS. CMR predicted type-I pattern with a sensitivity of 97.3%, a positive predictive value of 92.0% and a negative predictive value of 95.8%. Maximal RVOT area coincided with maximal ST elevation in 28 out of 30 patients with respect to ICS and in 27 out of 30 patients according to sternal orientation.
Conclusions: CMR determined RVOT localization highly correlates with type-I Brugada pattern. Individual lead positioning according to RVOT location improves diagnosing Brugada syndrome.
- © 2011 by American Heart Association, Inc.