Abstract 15029: Validation of 2013 Diagnostic Criteria for Brugada Syndrome in a Cohort of 300 Individuals With Extensive Follow-Up
Brugada Syndrome (BrS) is a hereditary arrhythmogenic disorder that predisposes young patients to cardiac arrest (CA) or sudden cardiac death (SCD). In 2005 a consensus document defined the diagnostic criteria, which included the presence of a coved type ST-segment elevation ≥2mm in >1 right precordial lead in the fourth intercostal space (ICS). A recent HRS/EHRA/APHRS consensus document incorporating newer clinical observations states that a single ≥2mm coved lead in any ICS between second and fourth is the minimal requirement for diagnosis of BrS. We investigated the impact of the new criteria by applying them to a large cohort of subjects referred for a suspicion of BrS who did not match the 2005 criteria and were nonetheless followed at our center. Three hundred patients (86% males, age 36±13 years) with saddle-back or coved ST-segment elevation who displayed non-diagnostic electrocardiograms (ECGs) after class Ic drug infusion test and negative genetics entered the study. All patients had ECG with leads V1 and V2 recorded also in second, third or both ICS. We assessed 1,819 ECGs (median=5/patient) and found that the new diagnostic criteria allowed to diagnose BrS in 64/300 patients (21%; age 37±10 years; 51 males). We compared the natural history of these individuals to that of patients with BrS diagnosed in fourth ICS in our previously published BrS population. Between birth and last follow-up (41±13 years) CA/SCD occurred in 3/64 patients, 4.7% with an annual event rate (AER) of 0.1% that was identical to that of patients diagnosed with 2005 criteria who had a spontaneous coved pattern in the fourth ICS only during drug challenge (4/85 patients; AER 0.1%, see figure). In conclusion, our data demonstrate that a coved ST-segment elevation ≥2mm in V1 and/or V2 recorded in second, third or fourth ICS identifies patients with a risk profile superimposable to that of individuals with drug induced pattern in fourth ICS.
- © 2013 by American Heart Association, Inc.