Curcio Antonio, Mazzanti Andrea, Bloise Raffaella, Monteforte Nicola, Indolfi Ciro, Priori Silvia G, Napolitano Carlo
Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
Laboratory of Molecular Cardiology, IRCCS Salvatore Maugeri Foundation, Pavia, Italy.
J Cardiovasc Electrophysiol. 2016 Aug;27(8):937-43. doi: 10.1111/jce.12997. Epub 2016 Jun 15.
The 2013 HRS/EHRA/APHRS consensus statement recommends the use of V1 and V2 leads recorded in the second and third intercostal spaces (High-ICS) for diagnosis of Brugada syndrome (BrS) creating a new category of patients discovered only with modified leads. The clinical presentation and the arrhythmic risk in these patients are ill defined. This study was aimed at assessing the role of High-ICS in the analysis of BrS and the clinical profile of the patients diagnosed only when ECG leads are moved to upper intercostal spaces.
We searched our Brugada syndrome registry and identified 300 subjects (age 36 ± 13 years), without a diagnostic coved ST-segment elevation in conventional V1 -V3 leads, both at baseline and after provocative drug challenge. Sixty-four subjects (21.3%, mean age at last follow-up 42 ± 11 years) were diagnosed with High-ICS. Diagnosis was possible at baseline only in 4 subjects while in 60 it was made after drug challenge with sodium channel blockers. Three subjects (4.7%) with spontaneous abnormal ECG experienced cardiac events with an annual event rate (0.11%) superimposable to that of the low risk category of BrS diagnosed in standard leads.
This study demonstrates that the use of new diagnostic criteria for BrS allows increasing the diagnostic yield by 20% and that the arrhythmic risk is low when BrS can be established only in High-ICS. We also show that the prognostic value of spontaneous ECG pattern is confirmed in this subgroup.
2013年心脏节律学会（HRS）/欧洲心律协会（EHRA）/亚太心脏节律协会（APHRS）共识声明建议使用记录于第二和第三肋间（高位肋间，High-ICS）的V1和V2导联来诊断Brugada综合征（BrS），这使得一类仅通过改良导联才能发现的新患者群体得以确认。这些患者的临床表现和心律失常风险尚不明确。本研究旨在评估高位肋间导联在BrS分析中的作用以及仅在将心电图导联移至高位肋间时才被诊断出的患者的临床特征。
我们检索了我们的Brugada综合征注册库，确定了300名受试者（年龄36±13岁），其在常规V1 - V3导联基线及激发药物试验后均无诊断性的穹窿样ST段抬高。64名受试者（21.3%，最后随访时平均年龄42±11岁）通过高位肋间导联被诊断为BrS。仅4名受试者在基线时即可诊断，而60名受试者是在使用钠通道阻滞剂进行药物激发试验后确诊。3名（4.7%）有自发异常心电图的受试者发生了心脏事件，年事件发生率（0.11%）与标准导联诊断的低风险类别BrS相当。
本研究表明，使用BrS新诊断标准可使诊断率提高20%，且仅在高位肋间导联能确诊BrS时心律失常风险较低。我们还表明，该亚组中自发心电图模式的预后价值得到了证实。
