Prognostic Value of Small Coved-Type ST-Segment Area in Patients With Spontaneous Type 1 Brugada Syndrome
Nario Sano1, Tetsuji Shinohara1, Keisuke Yonezu1
1Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, Japan.
Insights
A small coved-type ST-segment area on ECG may predict ventricular fibrillation (VF) in Brugada syndrome (BrS) patients. This finding could improve risk stratification for individuals with spontaneous Type 1 BrS.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Diagnostics
Background:
- Brugada syndrome (BrS) risk stratification is challenging.
- Established markers include spontaneous Type 1 ECG and clinical history (e.g., syncope, prior ventricular fibrillation [VF]).
- Additional electrocardiographic predictors are needed for refined prognostication.
Purpose of the Study:
- To investigate the association between the maximum coved-type ST-segment area and VF occurrence in BrS patients.
- To identify novel electrocardiographic markers for predicting VF in BrS.
Main Methods:
- Retrospective analysis of 60 patients with spontaneous Type 1 BrS.
- Quantification of maximum coved-type ST-segment area in leads V1-V3.
- Categorization into VF-occurrence and non-occurrence groups for comparison.
Main Results:
- A smaller maximum coved-type ST-segment area was significantly associated with VF occurrence (p=0.022).
- Inferolateral J waves and small ST-segment area were independent predictors of VF (p<0.001 and p=0.03, respectively).
- Lower VF-free survival was observed in patients with a small ST-segment area (p=0.034).
Conclusions:
- A small coved-type ST-segment area is independently associated with VF in spontaneous Type 1 BrS.
- This ECG finding may serve as a valuable marker for risk stratification in BrS.
- Further research can explore its utility in clinical decision-making.
Background:
Risk stratification in Brugada syndrome (BrS) remains challenging. Although spontaneous Type 1 ECG and clinical history (e.g., prior ventricular fibrillation [VF] or syncope) are established risk markers, additional electrocardiographic predictors are needed to refine prognostication.
Methods:
We retrospectively analyzed 82 consecutive BrS patients referred to Oita University Hospital. After excluding 20 patients with drug-induced and 2 with fever-induced Type 1 ECG, 60 patients with spontaneous Type 1 Brugada ECG were included. The maximum coved-type ST-segment area (mV·ms) was quantified across leads V1-V3 at standard and high-intercostal positions. Patients were categorized into VF-occurrence (n = 24) and non-occurrence (n = 36) groups.
Results:
Over a mean follow-up of 67 ± 59 months, 24 patients (40%) experienced VF. The maximum coved-type ST-segment area was significantly smaller in the VF-occurrence group compared with the non-occurrence group (27.7 ± 14.8 vs. 37.5 ± 16.7 mV·ms; p = 0.022). In multivariate analysis, inferolateral J waves (OR 11.1; 95% CI 2.85-42.8; p < 0.001) and a small maximum coved-type ST-segment area (OR 5.47; 95% CI 1.17-25.7; p = 0.03) were independent predictors of VF. Kaplan-Meier analysis showed significantly lower VF-free survival in patients with a small maximum coved-type ST-segment area (p = 0.034).
Conclusions:
In patients with spontaneous Type 1 BrS, a small coved-type ST-segment area may be independently associated with VF and may represent a potential electrocardiographic marker for risk stratification.
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