aVR sign as a risk factor for life-threatening arrhythmic events in patients with Brugada syndrome

Heart Rhythm. 2007 Aug;4(8):1009-12. doi: 10.1016/j.hrthm.2007.04.017. Epub 2007 May 4.


Background: Risk stratification in Brugada syndrome (BS) is controversial, especially in asymptomatic individuals.

Objective: The aim of this study was to evaluate the significance of lead aVR in patients with BS.

Methods: Twenty-four patients with the electrocardiogram pattern of BS (24 male, mean age 32.1 +/- 13.6 years) and 24 healthy age- and gender-matched controls were studied.

Results: Thirteen patients were symptomatic. The R-wave amplitude or R/q ratio in lead aVR was significantly greater in patients experiencing a recurrence compared with those who did not. The aVR sign was defined as R wave >/= 0.3 mV or R/q >/= 0.75 in lead aVR. Most of the recurrences (78%) were in patients with present aVR sign; 84% of BS patients with present aVR sign had events during follow-up. In contrast, only 27% of BS patients with absent aVR sign had events during follow-up.

Conclusion: Our study shows significant correlation between a prominent R wave in lead aVR (aVR sign) and risk for development of arrhythmic events in BS. In the presence of BS, prominent R wave in lead aVR may reflect more right ventricular conduction delay and subsequently more electrical heterogeneity, which in turn is responsible for a higher risk of arrhythmia.

MeSH terms

  • Adult
  • Brugada Syndrome / diagnosis*
  • Electrocardiography*
  • Electrophysiologic Techniques, Cardiac
  • Humans
  • Male
  • Middle Aged
  • ROC Curve
  • Risk Assessment
  • Risk Factors