SPC365

Utility of resting electrocardiogram in screening and risk stratification of Brugada Syndrome

Session: Sessão de Posters 28 - Morte súbita cardíaca
Speaker: Vanda Neto

Congress: CPC 2024
Topic: C. Arrhythmias and Device Therapy
Theme: 08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme: 08.4 Ventricular Arrhythmias and SCD - Treatment
Session Type: Cartazes
FP Number: ---
Authors: Vanda Devesa Neto; João Fiúza; Gonçalo Ferreira; Mariana Almeida; Inês Pires; Júlio Gil Pereira; António Costa; Luís Ferreira Santos
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:14.0pt">Introduction</span></strong><span style="font-size:14.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: Identifying high-risk patients in Brugada Syndrome (BrS) remains challenging. This study aims to determine which intervals in resting ECG differentiate between healthy and affected individuals and correlate these baseline ECG intervals with cardiovascular events over a 10-year period.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:14.0pt">Methods:</span></strong><span style="font-size:14.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">&nbsp;P<span style="color:#1f1f1f">rospective, longitudinal&nbsp;study that included 107 consecutive patients with first-degree relatives diagnosed with Brugada Syndrome, submitted to an </span>ECG <span style="color:#1f1f1f">in 2009 for </span>screening of type 1 BrS&nbsp;in a Portuguese center. Patients with a normal baseline ECG were submitted to provocative test with flecainide to diagnose an induced type 1 Brugada pattern based on the clinician judgment at the time. Genetic tests were performed for BrS diagnosis. Quantitative ECG parameters of interest included PR, QRS and QTc interval (ms), and presence of QRS fragmentation. &nbsp;After subgroup stratification (spontaneous type 1 (SBr), induced type 1 (IBr) or normal ECG) patients were submitted to clinical follow-up for 10 years, assessing cardiac events (CE), which were defined as sudden cardiac death (SCD), ICD implantation and ICD shocks. Clinical records were used characterize time to event and type of event. <span style="background-color:white"><span style="color:#212529">Chi-square and Mann-Whitney U tests were used for group comparisons; survival analysis used Kaplan-Meier curves; Cox regression analysis was used for multivariable analysis.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:14.0pt">Results:</span></strong><span style="font-size:14.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> 107 patients; 16 SBr and 11 IBr. Mean age 29.9&plusmn;16years; 51 male. Genetic test positive in 36%. 6.5% implanted CDI at baseline. </span></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:14.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Both SBr (202.5&plusmn;32.8 vs 150.2&plusmn;29.3ms; <em>p</em>&lt;0.01) and IBr (177.3&plusmn;33.5 vs 150.2&plusmn;29.3ms; <em>p</em>=0.02) patients had significantly higher PR intervals vs normal ECG. No differences were found in PR interval between SBr and IBr (<em>p</em>=0.93). QRS interval was significantly higher in patients with SBr vs normal ECG (110.0&plusmn;16.3 vs 89.5&plusmn;15.6; p&lt;0.01).&nbsp;</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:14.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">In SBr CE occurred in 41.5% (3 ICD implantation, 1 ICD shock, and 1 SCD). In IBr 18.2% experienced CE (2&nbsp; ICD implantation). No CE were reported in the population with a normal ECG and normal provocative test.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:14.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Cox Regression analysis demonstrated that PR interval was an independent predictor of earlier CE [HR 1.06 CI95% (1.02;1.10); <em>p</em>&lt;0.01], adjusted to other significant clinical variables such as familiar SCD, SBr and positive genetic test.&nbsp;</span></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:14.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Mean time taken for a CE was significantly shorter in the group with PR&gt;200ms (283 vs 304 months, <em>p</em>&lt;0.01). </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:14.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">ROC analysis demonstrated that the PR interval exhibits highly predictive effect concerning CE (AUC 0.896; p &lt; 0.01; 95% CI 0.79; 1.00) and emerged as a superior predictor of CE when compared to familiar&nbsp;SCD (AUC 0.681)&nbsp;and positive genetic test (AUC 0.723)</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:14.0pt">Conclusion:</span></strong><span style="font-size:14.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> Resting ECG, particularly the PR interval, proves valuable in identifying individuals at risk for BrS-related cardiac events. Early detection and risk stratification using baseline ECG findings can guide individual risk stratification&nbsp;management.</span></span></span></span></p>