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Family screening for Brugada syndrome – ECG parameters as a useful screening tool
Session:
Posters (Sessão 3 - Écran 4) - Morte súbita cardíaca
Speaker:
ANGELA MARGARIDA MARTINS DE CASTRO
Congress:
CPC 2023
Topic:
C. Arrhythmias and Device Therapy
Theme:
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme:
08.7 Ventricular Arrhythmias and SCD - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Margarida De Castro; Filipa Cardoso; Tamara Pereira; Mariana Tinoco; Luísa Pinheiro; Bebiana Faria; Margarida Oliveira; Lucy Calvo; João Português; Sílvia Ribeiro; Victor Sanfins; António Lourenço
Abstract
<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><strong><span style="font-size:10.0pt">Introduction</span></strong><span style="font-size:10.0pt">: </span><span style="font-size:10.0pt">Brugada Syndrome (BrS) is a primary electrical disorder with </span><span style="font-size:10.0pt">autosomal dominant transmission. Family screening for BrS can be challenging specially in asymptomatic individuals with normal basal electrocardiogram. </span></span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><strong><span style="font-size:10.0pt">Purpose</span></strong><span style="font-size:10.0pt">: The aim of this study was to define whether there are clinical and electrocardiographic criteria that can predict the diagnosis of BrS. </span></span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><strong><span style="font-size:10.0pt">Methods:</span></strong> <span style="font-size:10.0pt">Retrospective single-center analysis of 215 patients (pts) with family history of BrS referenced for screening between September of 2012 and January of 2022. Nine patients with spontaneous type 1 Brugada pattern in basal ECG were excluded. All patients underwent a clinical consultation and electrocardiogram evaluation. Healthy individuals were compared with those in whom screening revealed a definitive BrS diagnosis, by univariate and binary logistic regression analysis.</span></span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><strong><span style="font-size:10.0pt">Results:</span></strong> <span style="font-size:10.0pt">From our 206 pts remaining, 45,6% were male with a mean age of 48±16 years old. Definitive diagnosis of BrS was made in 61,7%, of which 97 were diagnosed by provocative test with </span><span style="font-size:10.0pt">sodium channel blocking drugs while 30 had an identified pathogenic mutation; syncope occurred in 39,4% and 20,5% had family history of sudden cardiac death (SCD).</span></span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><span style="font-size:10.0pt">By univariate analysis, previous symptoms as syncope and nocturnal agonic breathing, type 2 or 3 ECG pattern, positive R-wave sign in aVR and fragmented QRS (<em>p</em>=0,002; <em>p</em><0,001; <em>p</em>=0,011; <em>p</em>=0,004) were all associated with BrS diagnosis. Affected individuals had larger QRS (106±20ms vs 101±19ms, <em>p=</em> 0,001) and higher R-wave in lead aVR (0,10±0,15mV vs 0,00±0,05mV, <em>p</em>=0,000) when compared with healthy ones. </span></span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><span style="font-size:10.0pt">By multivariate analysis, the presence of previous symptoms (OR=2,5; p=0,014, CI=1,204-5,052) and a type 2 or 3 pattern on the ECG (OR=3,9; <em>p</em>=0,022, CI=1,218-13,126) were independent predictors of a definitive diagnosis.</span></span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><strong><span style="font-size:10.0pt">Conclusions: </span></strong><span style="font-size:10.0pt">When screening asymptomatic BrS family members, certain clinical and electrocardiographic criteria such as the presence of symptoms, l</span><span style="font-size:10.0pt">arger QRS intervals, a positive R-wave sign and a type 2 or 3 ECG pattern on basal ECG were associated with definitive diagnosis. These results may point to a more cost-effective selection of family members to screen. </span></span></p>
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