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Prediction of ventricular arrhythmias in patients with a spontaneous Brugada type 1 pattern: the key is in the

Antoine Delinière1, Adrian Baranchuk2, Joris Giai3,4

  • 1Service de Rythmologie, Centre National de Référence des Troubles du Rythme Cardiaque Héréditaires de Lyon, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Avenue du Doyen Jean Lépine, 69500 Bron, France & Université de Lyon, Lyon, France.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|June 10, 2019
PubMed

Insights

A new risk prediction model identifies patients with Brugada type 1 pattern (BrT1) at high risk for ventricular fibrillation or sudden cardiac arrest (VF/SCA). The model uses electrocardiogram (ECG) markers like LMaxTpec, peripheral T1 (pT1), and early repolarization (ER) to quantify risk.

Area of Science:

  • Cardiology
  • Medical Diagnostics
  • Predictive Analytics

Background:

  • Brugada type 1 pattern (BrT1) is associated with increased risk of life-threatening arrhythmias like ventricular fibrillation or sudden cardiac arrest (VF/SCA).
  • Currently, no reliable tool exists to quantify VF/SCA risk in patients with spontaneous BrT1.
  • Electrocardiogram (ECG) markers of depolarization and repolarization abnormalities may indicate elevated risk.

Purpose of the Study:

  • To develop and validate a risk prediction model for VF/SCA in adult patients with spontaneous BrT1.
  • To identify specific ECG markers associated with VF/SCA events in this patient population.

Main Methods:

  • Retrospective analysis of ECG data from 115 adult patients with spontaneous BrT1 (45 with VF/SCA, 70 without).
  • Evaluation of 10 ECG markers for association with VF/SCA.
  • Application of Cox multivariate analysis and a multidimensional penalized spline model for risk prediction.

Main Results:

  • Significant univariate associations found between VF/SCA and LMaxTpec (maximum corrected Tpeak-Tend intervals ≥100ms in precordial leads), pT1 (BrT1 in a peripheral lead), ER (early repolarization in inferolateral leads), and QRS duration ≥120ms in lead V2.
  • Multivariate analysis identified LMaxTpec, LMaxTpec + ER, LMaxTpec + pT1, and LMaxTpec + pT1 + ER as significant predictors of VF/SCA.
  • A risk prediction model incorporating age and these ECG markers was developed.

Conclusions:

  • LMaxTpec, particularly when combined with pT1 and/or ER, strongly indicates elevated VF/SCA risk in adult patients with spontaneous BrT1.
  • A simple, effective risk prediction model for VF/SCA has been developed using age and key ECG markers.
Abstract

Keywords:
Brugada syndromeElectrocardiogramRisk stratificationSpontaneous Brugada type 1Sudden deathVentricular fibrillation

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