Evaluation of baseline ECG in patients undergoing Oral Flecainide Challenge test for suspected Brugada Syndrome: An analysis of lead II

Rai, Maneesh K and Prabhu, Mukund A and Kamath, Padmanabh K and Pai, Narasimha D and Kamath, Ramanath L (2017) Evaluation of baseline ECG in patients undergoing Oral Flecainide Challenge test for suspected Brugada Syndrome: An analysis of lead II. Indian Pacing and Electrophysiology Journal, 17 (4). pp. 102-107. ISSN 09726292

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Abstract

Background and Objectives: We analyzed Lead II in patients undergoing an Oral Flecainide Challenge test (FCT), to identify any pointers that could predict a positive FCT and thereby help in recognition of latent BS. Methods: The following parameters in lead II were retrospectively analyzed from the pre-test ECG in 62 patients undergoing FCT for suspected BS: The presence or absence of S waves, S wave amplitude, duration and upslope duration; J point parameters- Early repolarization, QRS notch, and QRS Slur; ST segment parameters-lack of isoelectric ST segment, ST duration and QT interval. Results: 48 had positive FCT (Group-1) while 14 were negative for FCT(Group-2). Lack of an isoelectric ST segment (50% vs 14.29%, p ¼ 0.018) and slurring of QRS (33.33% vs 0%, p ¼ 0.014) was more common in Group-1 than Group-2. Group-1 had shorter ST segment duration (median 81.5 (IQR 64e103.5) vs 110 (IQR 90e132), p ¼ 0.002) and shorter ST: QT ratio (median 0.28 (IQR 0.22e0.35) vs 0.23 (0.18e0.27), p ¼ 0.007). QRS notch/depressed J point (87.5%), QRS slur (100%), and lack of isoelectric ST segment (92.31%) had high sensitivity for predicting an inducible Type 1 Brugada pattern. Combining two parameters- ST: QT ratio<0.24 and lack of isoelectric ST segment-considerably improved the specificity (73.3%), and the positive predictive value of the test to 76%. The results remained accurate when validated in a small prospective cohort. Conclusion: Shortened ST segment in Lead II, lack of isoelectric ST segment, slurred QRS and ST/QT ratio <0.24 are predictive of underlying Brugada pattern in baseline ECG.

Item Type: Article
Uncontrolled Keywords: Brugada syndrome Flecainide challenge Electrocardiographic findings Inferior leads ST elevation
Subjects: Medicine > KMC Mangalore > Cardiology
Depositing User: KMCMLR User
Date Deposited: 18 Jan 2019 11:30
Last Modified: 18 Jan 2019 11:30
URI: http://eprints.manipal.edu/id/eprint/153064

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