Abstract 16606: Brugada-Like ECG Changes are Easily Induced With High Precordial Lead Position During Preparticipation ECG Screening in Collegiate Athletes
Introduction The use of high precordial leads in the 2nd or 3rd intercostal space is one means of evaluating patients with suspected Brugada syndrome. During our first year of preparticipation ECG screening at the University of North Carolina at Chapel Hill (UNC), we noted that right bundle branch block (RBBB) pattern and anterior early repolarization (“Brugada-like”) were easily inducible depending on ECG lead placement. We thus sought to assess the frequency at which a Brugada-like ECG pattern could be induced during preparticipation ECG screening.
Methods 235 incoming freshman in 2010-11 trying out for any varsity team or practice squad at UNC prospectively underwent two ECGs at the time of their preparticipation physical: one with leads in the standard lead positions, the second with V1 and V2 moved up to the second intercostal space. A “positive” ECG was defined as a new RSR’ pattern and/or ST elevation pattern present in the high lead ECG in V1 or V2 that was absent in the baseline ECG. Findings on ECG were also recorded based on the classification of abnormalites of the athlete's ECG as outlined in the recent European Society of Cardiology recommendations.
Results No athletes had complete RBBB, and incomplete RBBB was present in 21 at baseline. Of the remaining 214 athletes, a Brugada-like pattern was inducible with the high lead ECG in 99 (46%), and of these, 69 were male. There was no significant difference between those with a positive or negative ECG in regards to sport or BMI. A typical baseline (Fig A) and “positive” ECG (Fig B) are shown.
Conclusion In our athletes without preexisting incomplete RBBB, a Brugada-like pattern was easily obtained and highly prevalent with high placement of anterior precordial leads. Careful placement of leads is essential to avoid false positive findings. Our future work will involve comparing screened athletes with a similarly-aged, nonathlete control group and further definition of “normal” ECG findings in our athletes.
- © 2011 by American Heart Association, Inc.