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European Heart Journal Advance Access published online on September 4, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl205
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received November 22, 2005
Revised July 27, 2006
Accepted August 10, 2006

Clinical research

A prospective study on spontaneous fluctuations between diagnostic and non-diagnostic ECGs in Brugada syndrome: implications for correct phenotyping and risk stratification

Christian Veltmann 1 *, Rainer Schimpf 1, Constanze Echternach 1, Lars Eckardt 2, Juergen Kuschyk 1, Florian Streitner 1, Susanne Spehl 1, Martin Borggrefe 1, and Christian Wolpert 1

1 First Department of Medicine, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
2 Department of Cardiology and Angiology, Universitätsklinikum Muenster, Muenster, Germany

* To whom correspondence should be addressed.
Christian Veltmann, E-mail: christian.veltmann{at}med.ma.uni-heidelberg.de


  Abstract

Aims Fluctuations between the diagnostic ECG pattern and non-diagnostic ECGs in patients with Brugada syndrome are known, but systematic studies are lacking. The purpose of this study was to prospectively evaluate the spontaneous ECG changes between diagnostic and non-diagnostic ECG patterns in patients diagnosed with Brugada syndrome.

Methods and results In 43 patients with Brugada syndrome (27 males; mean age 45 ± 11 years), 310 resting ECGs were obtained during a median follow-up of 17.7 months. The ECGs were analysed for the presence of coved type, saddle-back type or no, respectively unspecific, changes. A coved-type ECG pattern with more than 2 mm ST-segment elevation in at least two right precordial leads was defined as diagnostic. The patients were compared for different clinical characteristics with respect to the pattern of fluctuations. Out of a total of 310 ECGs, 102 (33%) revealed a coved type, 91 (29%) a saddle-back type, and 117 (38%) a normal ECG. Fifteen patients (35%) initially presented with a diagnostic coved-type ECG. Fourteen patients (33%) with an initially coved-type ECG exhibited intermittently non-diagnostic ECGs during follow-up. Only one patient (2%) presented constantly with a coved-type ECG. Out of 28 patients (65%) with an initially non-diagnostic ECG, eight (19%) patients developed a diagnostic coved-type ECG during follow-up. Twenty patients (47%) revealed a coved-type ECG during ajmaline challenge, but never had a baseline coved-type ECG recorded. No significant differences were found in gender and clinical characteristics among patients with or without fluctuations between diagnostic and non-diagnostic basal ECGs. The rate of inducible ventricular fibrillation was significantly higher in patients with more than 50% coved-type ECGs than in patients with less than 50% diagnostic ECGs.

Conclusion The prevalence of fluctuations between diagnostic and non-diagnostic ECGs in patients with Brugada syndrome is high and may have an implication on the correct phenotyping and on the risk stratification in patients with Brugada syndrome without aborted sudden cardiac death. For correct phenotyping and risk stratification, repetitive ECG recordings seem to be mandatory.

Keywords: Brugada syndrome; Risk stratification; ECG; ECG fluctuation; Sudden cardiac death.
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