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Role of late-potentials in signal-averaged ECG in predicting flecainide provocative test in Brugada pattern
Session:
Painel 4 - Arritmologia 7
Speaker:
Joana Brito
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme:
08.5 Ventricular Arrhythmias and SCD - Prevention
Session Type:
Posters
FP Number:
---
Authors:
Joana Brito; N. Cortez-Dias; N. Nunes-Ferreira; J. Rigueira; P. Silverio Antonio; Tiago Graça Rodrigues; Irina Neves; Nelson P. Cunha; Mafalda Carrington; Inês Aguiar Ricardo; Gustavo Lima Silva; Andreia Magalhães; Fausto José Pinto; João Rodrigues De Sousa
Abstract
<p><strong>Introduction</strong></p> <p>In Brugada Syndrome (BrS) risk of sudden cardiac death is higher in patients with spontaneous type 1 pattern. Brugada pattern is also established in patients with induced type 1 morphology after provocative test with intravenous administration with a sodium blocker channel. Nevertheless, this group is known to be at a lower risk of SCD, and their risk stratification is still a matter of discussion. Late potentials (LP) on signal-averaged ECG (SAECG) measured on the RVOT have been previously proposed as a predictor factor for BrS, even though data is lacking on its predictive value.</p> <p><strong>Purpose</strong></p> <p>To evaluate the association between positive LP (LMS<sub>40</sub>> 38ms) on SAECG with modified Brugada leads and a positive flecainide test in patients with non-type 1 BrS.</p> <p> </p> <p><strong>Methods </strong></p> <p>Retrospective single-center study of non-type 1 BrS patients referred for the performance of a flecainide provocative test. Patients presenting with spontaneous type 1 morphology were excluded from the study. Study of LP on SAECG with modified leads for Brugada were evaluated before administration of flecainide [2mg/kg (maximum150mg), for 10minutes] with determination of filtered QRS duration (fQRS), root mean square voltage of the last 40ms of the QRS complex (RMS<sub>40</sub>) and duration of low amplitude signals <40μV of the terminal QRS complex (LMS<sub>40</sub>).</p> <p> </p> <p><strong>Results</strong></p> <p>126 patients (47.3±14.1 years, 61.9% males) underwent study with LP SAECG and flecainide test. From these patients, 7.9% were symptomatic and 16.7% had familiar history of BrS. Flecainide test was positive in 46.8% of these cases.</p> <p>In patients with a positive flecainide test, 64.4% presented LMS<sub>40</sub>>38ms whereas LMS<sub>40</sub>>38ms was present in only 46% of patients with a negative flecainide test (p=0.031). The presence of positive LMS<sub>40 </sub>was a positive predictor for a positive flecainide test, associated with a two-fold increase likelihood in the induction of a Brugada pattern (OR: 2,12; IC95% 1,025-4,392; P=0,043).</p> <p>There was no association between fQRS or RMS<sub>40 </sub>and a positive flecainide test (p=NS). fQRS>114ms and RMS<sub>40</sub> <20uV was present in only 22% and 61% of patients with a positive flecainide test, respectively.</p> <p> </p> <p><strong>Conclusion</strong></p> <p>In patient with non-type 1 Brugada syndrome, LMS<sub>40 </sub>> 38ms evaluated was a predictor for a positive flecainide test, suggesting that this late potential could be helpful on the risk stratification of patients undergoing study for Brugada syndrome.</p>
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