Quantitative assessment of ST segment elevation in Brugada patients

Extramiana, Fabrice; Seitz, Julien; Maison-Blanche, Pierre; Badilini, Fabio; Haggui, Abdeddayem; Takatsuki, Seiji; Milliez, Paul; Denjoy, Isabelle; Cauchemez, Bruno; Beaufils, Philippe; Leenhardt, Antoine

doi:10.1016/j.hrthm.2006.06.010

« Previous Next »Heart Rhythm
Volume 3, Issue 10 , Pages 1175-1181, October 2006

Quantitative assessment of ST segment elevation in Brugada patients

Fabrice Extramiana, MD, PhD
- Lariboisière University Hospital, Paris, France
- Address reprint requests and correspondence: Fabrice Extramiana, Cardiology Department, Lariboisière University Hospital, 2 rue Ambroise Paré, 75475 Paris Cedex 10, France.
Julien Seitz, MD
- Lariboisière University Hospital, Paris, France
Pierre Maison-Blanche, MD
- Lariboisière University Hospital, Paris, France
Fabio Badilini, PhD
- AMPS, LLC, New York, New York
Abdeddayem Haggui, MD
- Lariboisière University Hospital, Paris, France
Seiji Takatsuki, MD
- Lariboisière University Hospital, Paris, France
Paul Milliez, MD, PhD
- Lariboisière University Hospital, Paris, France
Isabelle Denjoy, MD
- Lariboisière University Hospital, Paris, France
Bruno Cauchemez, MD
- Lariboisière University Hospital, Paris, France
Philippe Beaufils, MD
- Lariboisière University Hospital, Paris, France
Antoine Leenhardt, MD
- Lariboisière University Hospital, Paris, France

Received 21 April 2006; accepted 8 June 2006. published online 16 June 2006.

Background

ST segment elevation in the right precordial leads constitutes the electrocardiogram (ECG) hallmark of Brugada syndrome (BS). This pattern is variable and can be concealed, but the magnitude and the cause of ST segment fluctuations have been poorly investigated.

Objective

Our goal was to quantify ST changes and to assess rate and autonomic influences on ST level.

Methods

A 12-lead ECG was continuously recorded during 24 hours in 20 patients with BS (ages 49 ± 12) and 10 healthy subjects (ages 32 ± 7). Using two-dimensional binning we obtained average QRS-T complexes every 30 minutes (time bins) and at different RR intervals (rate bins) for each subject. ST level was measured at five different points located 90, 100, 110, 120, and 140 ms after Q onset (Qo). In BS patients, the highest ST elevation was measured 110 ms after Qo (Qo+110).

Results

ST level changes between time points were significantly greater in patients with BS compared with control subjects: on lead V2, the range of ST level at Qo+110 was 264 ± 85 μV in BS and 91 ± 22 μV in control subjects (P <.01). In BS, ST level decreased with heart rate acceleration: the difference in ST level at Qo+110 for RR = 900 and 600 ms was 55 ± 53 μV (P <.01). HFnu was positively, although weakly, correlated with ST level (R² = 0.02, P <.01).

Conclusions

ECG changes observed in patients with BS are related in part to heart rate influences on ST segment level. These spontaneous fluctuations over a 24-hour time period suggest that Holter recordings may improve the ECG diagnosis sensitivity in BS.

Keywords: Electrocardiography , Heart rate , Brugada syndrome