Diagnostic utility of bipolar precordial leads during ajmaline testing for suspected Brugada syndrome

Batchvarov, Velislav N.; Govindan, Malini; Macfarlane, Peter; Camm, A. John; Behr, Elijah R.

doi:10.1016/j.hrthm.2009.10.005

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Volume 7, Issue 2 , Pages 208-215, February 2010

Diagnostic utility of bipolar precordial leads during ajmaline testing for suspected Brugada syndrome

Velislav N. Batchvarov, MD
- Division of Cardiac and Vascular Sciences, St. George's University of London, London, United Kingdom
- Address reprint requests and correspondence: Dr. Velislav N. Batchvarov, Division of Cardiac and Vascular Sciences, St. George's University of London, Cranmer Terrace, London SW17 0RE, United Kingdom
Malini Govindan, BMed, FRACP
- Division of Cardiac and Vascular Sciences, St. George's University of London, London, United Kingdom
Peter Macfarlane, DSc, FRCP (Glasg), FESC, FRSE
- University Department of Medical Cardiology, Royal Infirmary, Glasgow, Scotland
A. John Camm, MD, FRCP, FESC, FAHA, FHRS
- Division of Cardiac and Vascular Sciences, St. George's University of London, London, United Kingdom
Elijah R. Behr, MD, MRCP
- Division of Cardiac and Vascular Sciences, St. George's University of London, London, United Kingdom

Received 8 June 2009; accepted 5 October 2009. published online 12 October 2009.

Background

Leads V₁ and V₂ recorded from the standard position (fourth intercostal space) have insufficient sensitivity to detect the diagnostic type 1 Brugada ECG pattern.

Objective

The purpose of this study was to compare the sensitivity of bipolar leads with a positive pole at V₂ and a negative pole at V₄ or V₅ with that of the standard unipolar lead V₂ for detection of the type 1 Brugada pattern.

Methods

We analyzed digital 15-lead ECGs (12 standard leads plus leads V₁ to V₃ recorded from the third intercostal space [V_1h to V_3h]) acquired during diagnostic ajmaline testing in 128 patients (80 men, age 37 ± 15 years) with suspected Brugada syndrome and standard 12-lead ECGs recorded in 229 healthy subjects (111 men, age 33 ± 4 years). Bipolar leads between V₂ (positive pole) and V₄ or V₅ (leads V_2–4, V_2–5) were derived by subtracting leads V₄ and V₅ from V₂. All ECGs were examined for the presence of type 1 Brugada pattern.

Results

During 21 (16.4%) positive ajmaline tests, type 1 pattern was observed in lead V_2h during 20 tests (95.2%) and in V₂ during 10 tests (47.6%). Type 1 pattern appeared in lead V_2–4 or V_2–5 in all tests when it was present in V₂ and in seven tests during which it was observed in lead V_2h but not V₂ (17 tests [81%]). Type 1–like pattern was observed in lead V_2–4 or V_2–5 during two nonpositive tests (1.9%) and in one healthy subject (0.4%).