Brugada pattern changes during tilt table test with high precordial leads. An exploratory data to better understand...

Area of Science:

• Cardiology
• Electrophysiology
• Autonomic Nervous System

Background:

• Brugada Syndrome (BrS) is characterized by a dynamic type 1 Brugada electrocardiogram pattern (Br1ECGp).
• The Br1ECGp is influenced by the balance between sympathetic and parasympathetic nervous system activity.
• This pattern is often more pronounced during vagal nerve stimulation, such as sleep or post-meal states.

Purpose of the Study:

• To investigate the dynamic changes of the Br1ECGp during a tilt table test.
• To assess the utility of high precordial leads in conjunction with the tilt table test for evaluating autonomic responses in BrS patients.

Main Methods:

• An observational, cross-sectional, hypothesis-generating pilot study was conducted.
• The tilt table test was performed on three BrS patients.
• High precordial leads were added to the standard ECG protocol, and continuous recordings analyzed variations during all test phases.

Main Results:

• One patient showed a transient Br1ECGp during the tilt table test, disappearing upon standing and reappearing upon recovery.
• Another patient exhibited a persistent Br1ECGp throughout the test.
• A third patient had a variable Br1ECGp response, with one instance of cardioinhibitory syncope.

Conclusions:

• The study demonstrated the dynamic nature of the Br1ECGp during autonomic stimulation via the tilt table test.
• High precordial leads enhance the visualization of these dynamic ECG changes.
• The findings reinforce the understanding that sympathetic and parasympathetic activity significantly modulates the Brugada ECG pattern.