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. Mar-Apr 2016;49(2):187-91.
doi: 10.1016/j.jelectrocard.2015.12.011. Epub 2015 Dec 23.

New Methodologies for Measuring Brugada ECG Patterns Cannot Differentiate the ECG Pattern of Brugada Syndrome From Brugada Phenocopy

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New Methodologies for Measuring Brugada ECG Patterns Cannot Differentiate the ECG Pattern of Brugada Syndrome From Brugada Phenocopy

Byron H Gottschalk et al. J Electrocardiol. .

Abstract

Background: Brugada phenocopies (BrP) are clinical entities characterized by ECG patterns that are identical to true Brugada syndrome (BrS), but are elicited by various clinical circumstances. A recent study demonstrated that the patterns of BrP and BrS are indistinguishable under the naked eye, thereby validating the concept that the patterns are identical.

Objective: The aim of our study was to determine whether recently developed ECG criteria would allow for discrimination between type-2 BrS ECG pattern and type-2 BrP ECG pattern.

Methods: Ten ECGs from confirmed BrS (aborted sudden death, transformation into type 1 upon sodium channel blocking test and/or ventricular arrhythmias, positive genetics) cases and 9 ECGs from confirmed BrP were included in the study. Surface 12-lead ECGs were scanned, saved in JPEG format for blind measurement of two values: (i) β-angle; and (ii) the base of the triangle. Cut-off values of ≥58° for the β-angle and ≥4mm for the base of the triangle were used to determine the BrS ECG pattern.

Results: Mean values for the β-angle in leads V1 and V2 were 66.7±25.5 and 55.4±28.1 for BrS and 54.1±26.5 and 43.1±16.1 for BrP respectively (p=NS). Mean values for the base of the triangle in V1 and V2 were 7.5±3.9 and 5.7±3.9 for BrS and 5.6±3.2 and 4.7±2.7 for BrP respectively (p=NS). The β-angle had a sensitivity of 60%, specificity of 78% (LR+ 2.7, LR- 0.5). The base of the triangle had a sensitivity of 80%, specificity of 40% (LR+ 1.4, LR- 0.5).

Conclusions: New ECG criteria presented relatively low sensitivity and specificity, positive and negative predictive values to discriminate between BrS and BrP ECG patterns, providing further evidence that the two patterns are identical.

Keywords: Base of triangle; Beta angle; Brugada ECG pattern; Brugada phenocopy; Brugada syndrome; ECG criteria.

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