Dynamic Expression of the Type 1 Brugada ECG Pattern During Tilt Table Testing Using Continuous High Precordial Lead
Eduardo Nolla Silva Pereira1, Luciana Sacilotto1, Tan Chen Wu1
1Cardiac Arrhythmias Unit, Instituto do Coração-InCor-HCFMUSP, Faculdade de Medicina, Hospital das Clínicas da Universidade de São Paulo, São Paulo 05403-900, Brazil.
Diagnostics (Basel, Switzerland)
|June 12, 2026
Summary
Tilt table testing with high-precordial leads does not unmask the Brugada ECG pattern (BrP1). Persistent BrP1 during testing may indicate higher syncope risk in Brugada syndrome patients.
Area of Science:
- Cardiology
- Electrophysiology
- Autonomic Nervous System
Background:
- The Type 1 Brugada ECG pattern (BrP1) is influenced by autonomic activity.
- Tilt table testing alters autonomic function, potentially affecting BrP1 expression.
- The clinical significance of BrP1 variability during tilt testing is unclear.
Purpose of the Study:
- To investigate the dynamic behavior of BrP1 during tilt table testing in Brugada syndrome patients.
- To assess the association between dynamic BrP1 expression and clinical characteristics.
- To determine if tilt table testing can serve as a diagnostic tool for BrP1.
Main Methods:
- Cross-sectional study of 44 Brugada syndrome patients undergoing tilt table testing.
- Continuous ECG monitoring with high-precordial leads during supine, tilt, nitrate, recovery, and syncope phases.
- Analysis of BrP1 expression variability and correlation with clinical data.
Main Results:
- BrP1 expression varied dynamically during tilt table testing.
- No new BrP1 was unmasked during tilt.
- Persistent BrP1 was associated with increased syncope and ICD implantation (p < 0.05).
Conclusions:
- Tilt table testing with high-precordial leads is not a diagnostic provocation tool for BrP1.
- The test can characterize autonomic modulation and phenotypic stability in Brugada syndrome.
- Prognostic value of dynamic BrP1 requires further prospective research.
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