Diagnostic utility of bipolar precordial leads during ajmaline testing for suspected Brugada syndrome

Batchvarov, V. N., Govindan, M., Macfarlane, P., Camm, A. J. and Behr, E. R. (2010) Diagnostic utility of bipolar precordial leads during ajmaline testing for suspected Brugada syndrome. Heart Rhythm, 7(2), pp. 208-215. (doi: 10.1016/j.hrthm.2009.10.005)

Abstract

BACKGROUND Leads V-1 and V-2 recorded from the standard position (fourth intercostal space) have insufficient sensitivity to detect the diagnostic type 1 Brugada ECG pattern. OBJECTIVE The purpose of this study was to compare the sensitivity of bipolar leads with a positive pole at V-2 and a negative pole at V-4 or V-5 with that of the standard unipolar lead V-2 for detection of the type 1 Brugada pattern. METHODS We analyzed digital 15-lead ECGs (12 standard leads plus leads V-1 to V-3 recorded from the third intercostal space [V-1h to V-3h]) acquired during diagnostic ajmaline testing in 128 patients (80 men, age 37 +/- 15 years) with suspected Brugada syndrome and standard 12-lead ECGs recorded in 229 healthy subjects (111 men, age 33 +/- 4 years). Bipolar leads between V-2 (positive pole) and V-4 or V-5 (leads V2-4, V2-5) were derived by subtracting leads V-4 and V-5 from V-2. All ECGs were examined for the presence of type 1 Brugada pattern. RESULTS During 21 (16.4%) positive ajmaline tests, type 1 pattern was observed in lead V-2h during 20 tests (95.2%) and in V-2 during 10 tests (47.6%). Type 1 pattern appeared in lead V2-4 or V2-5 in all tests when it was present in V-2 and in seven tests during which it was observed in lead V-2h but not V-2 (17 tests [ 81%]). Type 1-like pattern was observed in lead V2-4 or V2-5 during two nonpositive tests (1.9%) and in one healthy subject (0.4%). CONCLUSION Bipolar leads V2-4 and V2-5 are more sensitive than lead V2 for detection of the type 1 Brugada pattern

• Item Type: Articles
• Keywords: age, ajmaline test, bipolar lead, brugada syndrome, cellular basis, disease, duration, electrocardiograms, electrocardiography, England, epicardium, heart, mechanisms, men, p53, patient, patients, precordial lead, repolarization, st-segment elevation, tests, ventricular arrhythmia, ventricular outflow tract, ventricular repolarization
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Macfarlane, Professor Peter
• Authors: Batchvarov, V. N., Govindan, M., Macfarlane, P., Camm, A. J., and Behr, E. R.
• College/School: College of Medical Veterinary and Life Sciences
• Journal Name: Heart Rhythm
• ISSN: 1547-5271