Cor Vasa 2024, 66(4):411-416 | DOI: 10.33678/cor.2024.027
Baseline intervals in electrocardiogram for risk stratification in Brugada syndrome: A 10-year prospective study
- a Cardiology Department, Tondela-Viseu Hospital Centre, Viseu, Portugal
- b Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
Background: Risk stratification in Brugada syndrome (BrS) remains challenging. The aim of this study was to evaluate the baseline intervals in resting ECG of a cohort of Portuguese patients with first-degree relatives diagnosed with BrS and to identify ECG parameters associated with cardiac events (CE) over a 10-year period.
Methods: Prospective study assessing 107 Portuguese patients with first-degree relatives diagnosed with BrS and followed over a decade to detect CE. Subgroups included spontaneous type 1 (SB), inducible type 1 (IB), and normal ECG. CE were a composite endpoint comprising of sudden cardiac death (SCD), implantable cardioverter-defibrillator (ICD) implantation and appropriate ICD shocks.
Results: 15% patients with SB and 10% patients with IB, mean age was 29.9±16 years; 51% were male. SB and IB patients exhibited significantly higher PR intervals than those with normal ECG (p <0.01, p = 0.02, respectively). There were no differences in PR interval between SB and IB (p = 0.93). CE occurred in 41.5% of SB and in 18.2% of IB patients. No CE in patients with normal ECG and normal flecainide provocative test. PR interval was an independent predictor of earlier CE (HR 1.06 CI 95% [1.02-1.10]; p <0.01), adjusted to familiar SCD and positive genetic test. Mean time for a CE was significantly shorter in patients with PR >200 ms and the optimal cutoff value for predicting CE was 180 ms.
Conclusion: The PR interval is a significant parameter in basal ECG associated with CE in BrS. Considering the PR interval in the design of clinical algorithms is recommended for accurate individual risk assessment.
Keywords: Brugada syndrome, Electrocardiography, Risk stratification
Received: February 14, 2024; Revised: March 14, 2024; Accepted: March 19, 2024; Prepublished online: June 2, 2012; Published: September 9, 2024 Show citation
References
- Zeppenfeld J, Asano T, de Riva M, et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022;43:3997-4126.
Go to original source...
Go to PubMed...
- Honarbakhsh S, Providência R, Lambiase PD. Risk Stratification in Brugada Syndrome: Current Status and Emerging Approaches. Arrhythm Electrophysiol Rev 2018;7:79-83.
Go to original source...
Go to PubMed...
- Makiyama T, Akao M, Tsuji K, et al. High risk for bradyarrhythmic complications in patients with Brugada syndrome caused by SCN5A gene mutations. J Am Coll Cardiol 2005;46:2100-2106.
Go to original source...
Go to PubMed...
- Pranata R, Yonas E, Chintya V, et al. Association between PR Interval, First-degree atrioventricular block and major arrhythmic events in patients with Brugada syndrome - Systematic review and meta-analysis. J Arrhythm 2019;35:584-590.
Go to original source...
Go to PubMed...
- Honarbakhsh S, Providência R, Garcia-Hernandez J, et al. A Primary Prevention Clinical Risk Score Model for Patients with Brugada Syndrome (BRUGADA-RISK). JACC: Clin Electrophysiol 2021;7:210-222.
Go to original source...
Go to PubMed...
- Migliore F, Testolina M, Zorzi A, et al. First-degree atrioventricular block on basal electrocardiogram predicts future arrhythmic events in patients with Brugada syndrome: a long-term follow-up study from the Veneto region of Northeastern Italy. Europace 2019;21:322-331.
Go to original source...
Go to PubMed...
- Chung FP. Risk stratification beyond electrocardiographic manifestation in Brugada syndrome: The important parameter of PR interval. J Arrhythm 2019;35:591-592.
Go to original source...
Go to PubMed...
- Priori SG, Gasparini M, Napolitano C, et al. Risk stratification in Brugada syndrome: results of the PRELUDE (PRogrammed ELectrical stimUlation preDictive valuE) registry. J Am Coll Cardiol 2012;59:37-45.
Go to original source...
Go to PubMed...
- Milman A, Andorin A, Gourraud JB, et al. Profile of patients with Brugada syndrome presenting with their first documented arrhythmic event: data from the Survey on Arrhythmic Events in BRUgada Syndrome (SABRUS). Heart Rhythm 2018;15:716-724.
Go to original source...
Go to PubMed...
- Morita H, Watanabe A, Morimoto Y, et al. Distribution and prognostic significance of fragmented QRS in patients with Brugada syndrome. Circ Arrhythm Electrophysiol 2017;10:e004765.
Go to original source...
Go to PubMed...
- Junttila MJ, Brugada P, Hong K, et al. Differences in 12-lead electrocardiogram between symptomatic and asymptomatic Brugada syndrome patients. J Cardiovasc Electrophysiol 2008;19:380-383.
Go to original source...
Go to PubMed...
- Ohkubo K, Watanabe I, Okumura Y, et al. Prolonged QRS duration in lead V2 and risk of life-threatening ventricular arrhythmia in patients with Brugada syndrome. Int Heart J 2011;52:98-102.
Go to original source...
Go to PubMed...
- Huang Z, Patel C, Li W, et al. Role of signal averaged electrocardiograms in arrhythmic risk stratification of patients with Brugada syndrome: a prospective study. Heart Rhythm 2009;6:1156-1162.
Go to original source...
Go to PubMed...
- Maury P, Sacher F, Gourraud JB, et al. Increased Tpeak-Tend interval is highly and independently related to arrhythmic events in Brugada syndrome. Heart Rhythm 2015;12:2469-2476.
Go to original source...
Go to PubMed...
- Babai Bigi MA, Aslani A, Shahrzad S. aVR sign as a risk factor for life-threatening arrhythmic events in patients with Brugada syndrome. Heart Rhythm 2007;4:1009-1012.
Go to original source...
Go to PubMed...
- Ragab AAY, Houck CA, van der Does LJME, et al. Usefulness of the R-wave sign as a predictor for ventricular tachyarrhythmia in patients with Brugada syndrome. Am J Cardiol 2017;120:428-434.
Go to original source...
Go to PubMed...
- Calò L, Giustetto C, Martino A, et al. A new electrocardiographic marker of sudden death in Brugada syndrome: the S-wave in lead I. J Am Coll Cardiol 2016;67:1427-1440.
Go to original source...
Go to PubMed...
- Giustetto C, Nangeroni G, Cerrato N, et al. Ventricular conduction delay as marker of risk in Brugada syndrome. Results from the analysis of clinical and electrocardiographic features of a large cohort of patients. Int J Cardiol 2020;302:171-177.
Go to original source...
Go to PubMed...
- Fish JM, Antzelevitch C. Cellular mechanism and arrhythmogenic potential of T-wave alternans in the Brugada syndrome. J Cardiovasc Electrophysiol 2008;19:301-308.
Go to original source...
Go to PubMed...
- Gaita F, Cerrato N, Giustetto C, et al. Asymptomatic patients with Brugada ECG pattern: long-term prognosis from a large prospective study. Circulation 2023;148:1543-1555.
Go to original source...
Go to PubMed...
- Probst V, Veltmann C, Eckardt L, et al. Long-term prognosis of patients diagnosed with Brugada syndrome: results from the FINGER Brugada Syndrome Registry. Circulation 2010;121:635-643.
Go to original source...
Go to PubMed...
- El-Battrawy I, Pilsitz P, Liebe V, et al. Implantable cardioverter-defibrillator in Brugada syndrome: Long-term follow-up. Clin Cardiol 2019;42:958-965.
Go to original source...
Go to PubMed...
- Sieira J, Conte G, Ciconte G, et al. Prognostic value of programmed electrical stimulation in Brugada syndrome: 20 years experience. Circ Arrhythm Electrophysiol 2015;8:777-784.
Go to original source...
Go to PubMed...
- Satryan A, Kojuri J, Ben-Haim Y, et al. Sex-Related Differences in Cardiac Channelopathies. Circulation 2020;143:739-752.
Go to original source...
Go to PubMed...
- Benito B, Sarkozy A, Mont L, et al. Gender differences in clinical manifestations of Brugada syndrome. J Am Coll Cardiol 2008;52:1567-1573.
Go to original source...
Go to PubMed...
- Sacher F, Meregalli P, Veltmann C, et al. Are women with severely symptomatic brugada syndrome different from men? J Cardiovasc Electrophysiol 2008;19:1181-1185.
Go to original source...
Go to PubMed...
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