Unit of Cardiology, Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy -
Department of Cardiology, "S. Maria dei Battuti" Hospital, AULSS 2 Veneto, Conegliano, Treviso, Italy.
Minerva Cardiol Angiol. 2021 Aug;69(4):429-434. doi: 10.23736/S2724-5683.20.05278-0. Epub 2020 Jul 10.
Differentiation of Type 2 Brugada Pattern (BP) from incomplete right bundle branch block or normal rSr' pattern can be insidious. The aim of this study was to assess interobserver and intraobserver agreement in the diagnosis of type 2 BP in a cohort of cardiologists with different skills.
We collected 14 ECGs with a positive terminal deflection of the QRS complex in lead V1 and V2 at the 4 intercostal space. We proposed these ECGs, specifying to use 2012 Consensus conference criteria for diagnosis of type 2 BP, to 42 participants: 14 arrhythmologists, 14 general cardiologists and 14 electrophysiology (EP) fellows. The same 14 ECGs, with a different order, were proposed fifteen days later to the same cohort to assess intraobserver variability. Authors analyzed all 14 ECGs in order to assess whether 2012 Consensus Conference criteria for BP were fulfilled. All patients underwent provocative test with IC antiarrhythmics drugs (flecainide) in order to exclude or confirm the diagnosis of Brugada Syndrome (BrS).
Slight interobserver agreement (Fleiss K<0.20) in the diagnosis of type 2 BP was observed in all three categories of cardiologists. Considering five operators per class, intraobserver agreement is variable (k ranging from 0.000 to 0.857), with a slight superiority of arrhytmologists (k minimum value 0.276; k maximum value 0.857).
This study demonstrated, for the first time, a low interobserver agreement in diagnosis of type 2 BP in categories of cardiologists with different abilities. Reproducibility of type 2 BP diagnosis (intraobserver agreement) is poor, even among experts. These findings highlight the difficulties in analysis of ECG with BrS suspicion and, therefore, underscore the key role of clinical and anamnestic data.
2 型 Brugada 波（BP）与不完全性右束支阻滞或正常 rSr' 图形的鉴别可能很棘手。本研究旨在评估不同技能水平的心脏病专家在 2 型 BP 诊断中的观察者间和观察者内一致性。
我们收集了 14 例心电图，这些心电图在第 4 肋间 V1 和 V2 导联的 QRS 终末有正向偏转。我们向 42 名参与者提出了这些心电图，指定使用 2012 年共识会议标准诊断 2 型 BP，参与者包括 14 名心律失常专家、14 名普通心脏病专家和 14 名电生理（EP）研究员。15 天后，以不同的顺序向同一队列提出了相同的 14 份心电图，以评估观察者内变异性。作者分析了所有 14 份心电图，以评估 Brugada 综合征（BrS）是否符合 2012 年共识会议 BP 标准。所有患者均接受了 IC 抗心律失常药物（氟卡尼）的激发试验，以排除或确认 Brugada 综合征的诊断。
在所有三类心脏病专家中，2 型 BP 的诊断均存在轻微的观察者间一致性（Fleiss K<0.20）。考虑到每类 5 名操作者，观察者内一致性是可变的（k 值范围为 0.000 至 0.857），心律失常专家的优势稍大（k 值最小值为 0.276；k 值最大值为 0.857）。
本研究首次在不同能力的心脏病专家中观察到 2 型 BP 诊断的观察者间一致性较低。2 型 BP 诊断的可重复性（观察者内一致性）较差，即使是在专家中也是如此。这些发现突出了 Brugada 综合征可疑心电图分析的困难，因此强调了临床和病史数据的关键作用。
