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Electrocardiographic Non Type-1 Brugada pattern criteria in the young SCD-SOS cohort
Session:
Sessão de Comunicações Orais - Arritmias
Speaker:
Mafalda Carrington
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme:
08.3 Ventricular Arrhythmias and SCD - Diagnostic Methods
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Mafalda Carrington; Antonio; Diogo Brás; Ana Rita Santos; Antonio Creta; Rogerio Teixeira; Lino Gonçalves; Rui Providência
Abstract
<p><u>Introduction:</u> Differentiating non-Type 1 Brugada pattern (non-T1BrP) from an athlete’s ECG remains challenging. We aimed to study the diagnostic accuracy and the reproducibility of the measurements of the electrocardiographic non-T1BrP criteria in the young adults from the Sudden Cardiac Death-Screening Of risk factorS (SCD-SOS) cohort.</p> <p><u>Methods:</u> We performed a cross-sectional study in which we reviewed 14662 ECGs of SCD-SOS participants and selected 2494 that presented an rSr’ pattern in V1-V2. Among these, 98 were classified by an expert for the presence of non-T1BrP and we performed manual measurements of the diagnostic criteria. We estimated intraobserver concordance, as well as criteria accuracy and most appropriate cut-off points.</p> <p><u>Results:</u> We detected a rSr’-pattern in V1-V2 in 17% of the individuals and found that it was associated with higher PQ, QTc intervals, male gender and lower BMI. The manual measurement of non-T1BrP criteria was reproducible (minimal intraobserver concordance of 0.824; 95%CI 0.742-0.881) and accurate. The criteria with higher discriminatory capacity were the d(B) (AUC 0.807; 95% CI 0.736-0.878) and the ST-ascent (AUC 0.786; 95%CI 0.715-0.857). The previously defined cut-offs had very low sensitivity (19.23%), despite high specificity (95.65%), so we defined new cut-offs: d(A) ≥ 80ms (2mm), d(B) ≥ 48ms (1.25mm), d(B)/h ≥ 0.45 and β-angle ≥ 16.5º. The addition of the degree of ST-ascent to a model with these 4 parameters presented a C-statistics of 0.861 (95%CI 0.806-0.916) for the diagnosis of non-T1BrP by an expert in Sudden Arrhythmic Death and Channelopathies.</p> <p><u>Conclusion:</u> We showed that these 5 parameters of the r’-wave in V1/V2 are accurate and reproducible. Additionally, we re-defined cut-off points for the parameters that may help untrained clinicians to identify young individuals who should be referred for provocative drug testing for Brugada Syndrome.</p>
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