Unmasking Brugada-type electrocardiogram on deep inspiration

Area of Science:

• Cardiology
• Diagnostic Imaging
• Medical Technology

Background:

• Brugada syndrome (BrS) diagnosis can be challenging.
• Electrocardiogram (ECG) lead placement at upper intercostal positions is recommended for BrS diagnosis.
• Optimal conditions for unmasking ECG signs in BrS require further investigation.

Purpose of the Study:

• To evaluate the diagnostic utility of specific ECG recording techniques for unmasking Brugada syndrome (BrS) signs.
• To compare the effectiveness of upper intercostal lead placement, deep inspiration, and standing positions in revealing characteristic ECG abnormalities.

Main Methods:

• The study involved 34 patients diagnosed with or suspected of having Brugada syndrome (BrS).
• ECG recordings were compared at baseline, standard 4th intercostal space (4ICS) with deep inspiration (DI test), standing (Stand test), and 1 rib higher (3ICS) positions.
• Type 1 ECG and ST-elevation in leads V1-V3 were assessed across different recording conditions.

Main Results:

• While only 4 patients showed diagnostic ECG signs at baseline, 20 exhibited Type 1 ECG with deep inspiration (DI test) and 18 with 3ICS recording.
• Among patients without prior spontaneous Type 1 ECG, 7 showed signs with 3ICS recording and 6 with the DI test.
• The deep inspiration test demonstrated significant utility in unmasking diagnostic ECG criteria for BrS.

Conclusions:

• Electrocardiogram (ECG) recording during deep inspiration is a valuable method for unmasking diagnostic signs of Brugada syndrome (BrS).
• The diagnostic accuracy of the deep inspiration test is comparable to recording ECGs at the 3rd intercostal space (3ICS).