Guillem Maria S, Climent Andreu M, Millet José, Berne Paola, Ramos Rafael, Brugada Josep, Brugada Ramon
ITACA, Universitat Politècnica de València, Valencia, Spain.
Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
J Cardiovasc Electrophysiol. 2016 May;27(5):563-70. doi: 10.1111/jce.12937. Epub 2016 Mar 9.
The diagnosis of Brugada syndrome based on the ECG is hampered by the dynamic nature of its ECG manifestations. Brugada syndrome patients are only 25% likely to present a type 1 ECG. The objective of this study is to provide an ECG diagnostic criterion for Brugada syndrome patients that can be applied consistently even in the absence of a type 1 ECG.
We recorded 67-lead body surface potential maps from 94 Brugada syndrome patients and 82 controls (including right bundle branch block patients and healthy individuals). The spatial propagation direction during the last r' wave and the slope at the end of the QRS complex were measured and compared between patients groups. Receiver-operating characteristic curves were constructed for half of the database to identify optimal cutoff values; sensitivity and specificity for these cutoff values were measured in the other half of the database. A spontaneous type 1 ECG was present in only 30% of BrS patients. An orientation in the sagittal plane < 101º during the last r' wave and a descending slope < 9.65 mV/s enables the diagnosis of the syndrome with a sensitivity of 69% and a specificity of 97% in non-type 1 Brugada syndrome patients.
Spatiotemporal characteristics of surface ECG recordings can enable a robust identification of BrS even without the presence of a type 1 ECG.
基于心电图对Brugada综合征进行诊断受到其心电图表现动态变化特性的阻碍。Brugada综合征患者出现1型心电图的可能性仅为25%。本研究的目的是为Brugada综合征患者提供一种即使在没有1型心电图的情况下也能一致应用的心电图诊断标准。
我们记录了94例Brugada综合征患者和82例对照者（包括右束支传导阻滞患者和健康个体）的67导联体表电位图。测量并比较了患者组之间最后r'波期间的空间传播方向和QRS波群末端的斜率。为数据库的一半构建了受试者操作特征曲线以确定最佳截断值；在数据库的另一半中测量了这些截断值的敏感性和特异性。仅30%的Brugada综合征患者出现自发1型心电图。在最后r'波期间矢状面方向<101°且下降斜率<9.65 mV/s能够在非1型Brugada综合征患者中诊断该综合征，敏感性为69%，特异性为97%。
体表心电图记录的时空特征即使在没有1型心电图的情况下也能可靠地识别Brugada综合征。
