Electrocardiographic predictors of Brugada type response during Na channel blockade challenge

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Abstract

Aim: To identify ECG predictors of Brugada type response during Na channel blockade challenge. Methods: We studied prospectively 103 patients (M=76, 45±13 years) in whom ECGs were collected during ajmaline challenge. ECG recordings included the high right precordial leads (-2V1 and -2V2). A positive response was defined by a >0.2 mV J point or ST segment elevation and a down-sloping pattern of the ST segment in at least one right precordial lead. Results: Ajmaline challenge was pos itive in 48 (47%) of the 103 cases. Baseline J wave elevation was greater in -2V1 (0.077±0.078 mV vs. 0.038±0.046 mV, P=0.003) and -2V2 (0.149±0.103 mV vs. 0.043±0.088 mV, P<0.001) in cases with a subsequent positive response. In contrast, ST segment elevation and T wave amplitudes were reduced in V1, V2 and V3. Logistic regression showed that J wave elevation in -2V2 and decreased T wave amplitude in V3 at baseline were independent predictors of a positive response. Baseline J wave elevation >0.16 mV in -2V2 had a specificity of 100%, a sensitivity of 40%, a positive predictive value of 100% and a negative predictive value of 28%. Conclusion: J wave elevation >0.16 mV in -2V2 was the strongest predictor of a Brugada type response to Na channel blockade challenge when Brugada syndrome was suspected on a baseline ECG. © 2005 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.

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Hermida, J. S., Denjoy, I., Jarry, G., Jandaud, S., Bertrand, C., & Delonca, J. (2005). Electrocardiographic predictors of Brugada type response during Na channel blockade challenge. Europace, 7(5), 447–453. https://doi.org/10.1016/j.eupc.2005.05.005

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