• Cardiology Genomics Clinical Trials
• Cardiac Imaging Techniques
• Imaging Modalities

In a preliminary study, the use of additional electrocardiogram (ECG) leads was no more sensitive than standard 12-lead ECG assessment in detecting the signature ECG pattern of Brugada Syndrome (BrS), including right bundle branch block (RBBB), persistent ST-segment elevation in precordial leads V1 to V3, and normal QT interval.

BrS is a rare genetic disorder that increases the risk of sudden cardiac death (SCD). Diagnosis requires the detection of Type 1 ST-segment elevation, either spontaneously present or induced by a challenge with a class I antiarrhythmic (eg, ajmaline, flecainide). Traditional 12-lead ECG has a low sensitivity for Type 1 Brugada ECGs and may not detect the presence of this life-threatening syndrome. New research is focused on improving the detection of BrS with novel ECG lead placement.

Multichannel continuous ECG recording in the third intercostal space has been shown to be more sensitive for the diagnosis of Type 1 Brugada ECG than either repeated 12-lead ECGs or multichannel continuous ECG in the standard position [Shimeno K. J Cardiovasc Electrophysiol. 2009]. In the current study, Raymond Massay, BSc (Hons), MBBS, FRCP (Lon), University of the West Indies, Cave Hill, Barbados, and colleagues compared standard 12-lead placement with ECG using multiple leads that were positioned to view the right ventricular outflow tract (RVOT) in the detection of BrS.

The trial enrolled 15 patients from a private cardiology practice in Barbados. All patients had a history of syncope, a family history of SCD, and previously documented Brugada-type ECG findings. Neither ajmaline nor flecainide were unavailable as a challenge agent. Instead, patients were given procainamide 10 mg/kg IV over 10 minutes. Both standard ECG and ECG using the additional leads were recorded during drug administration and for 5 minutes thereafter.

Dr. Massay found no Brugada ECG patterns by either conventional or additional lead placement. Procainamide was well tolerated, with no arrhythmias, hypotension, or allergic reactions reported. A larger trial of patients who are challenged with either ajmaline or flecainide is necessary to provide any definitive conclusions about the use of additional ECG leads in screening for BrS.

• © 2010 MD Conference Express