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Association between the number of altered late potential criteria and increased arrhythmic risk in Brugada syndrome patients

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Abstract

Background

Brugada syndrome (BrS) is associated with abnormal electrophysiological properties at right ventricular epicardium, consisting of fragmented electrograms extending well beyond QRS termination. We aimed to evaluate the utility of signal-averaged electrocardiogram (SA-ECG) for the noninvasive assessment of late potentials (LP) and risk stratification of BrS patients.

Methods

A prospective, observational, single-center study of BrS patients is submitted to SA-ECG with the determination of the total filtered QRS duration (fQRS), root mean square voltage of the 40 ms terminal portion of the QRS (RMS40), and duration of the low-amplitude electric potential component of the terminal portion of the QRS (LAS40). LP were considered positive when above standard cut-offs: fQRS > 114 ms, RMS40 < 20 µV, and LAS40 > 38 ms. The rates of malignant arrhythmic events (MAEs), defined as sudden death or appropriate shocks, were compared in relation to clinical characteristics and SA-ECG findings.

Results

A total of 106 BrS patients (mean age, 48 ± 12 years, 67.9% male) were studied, 49% with type-1 spontaneous pattern and 81% asymptomatic. During a median follow up of 4.7 years, 10 patients (7.1%) suffered MAEs, including 4 sudden deaths. The presence of LP was significantly associated with the arrhythmic risk, which increased with the number of altered LP criteria. In comparison to the patients who had none or 1 altered LP criterium, MAE risk was 4.7 times higher in those with 2 altered criteria and 9.4 times higher in those with 3 altered LP criteria.

Conclusions

SA-ECG may be a useful tool for risk stratification in BrS. The presence of 2 or 3 abnormal LP criteria could identify a subset of asymptomatic patients at high risk of arrhythmic events.

Graphical Abstract

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Data availability

The data generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

BrS:

Brugada syndrome

fQRS:

Total filtered QRS duration

ICD:

Implantable cardiac defibrillator

LP:

Late potentials

LAS4o :

Low amplitude electric potential component of the terminal portion of the QRS

MAE:

Malignant arrhythmic events

RMS40 :

Root mean square voltage of the 40 ms terminal portion of the QRS

RVOT:

Right ventricular outflow tract

SA-ECG:

Signal-averaged electrocardiography

SCD:

Sudden cardiac arrest

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Author notes

  1. Joana Brito and Nuno Cortez-Dias contributed equally to this paper.

Authors and Affiliations

  1. Department of Cardiology, Santa Maria University Hospital, Lisbon Academic Medical Center and Cardiovascular Center of the University of Lisbon (CCUL@RISE), Lisbon, Portugal

    Joana Brito, Nuno Cortez-Dias, Gustavo Lima da Silva, Afonso Nunes Ferreira, Inês Aguiar Ricardo, Nelson Cunha, Pedro Silvério António, Irina Neves, Sandra Paiva, Ana Paixão, Fernanda Gaspar, Adília Silva, Andreia Magalhães, Pedro Marques, Fausto J. Pinto & João de Sousa

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  1. Joana Brito
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Correspondence to Joana Brito.

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Ethics approval and consent to participate

All patients provided written informed consent. The Institutional Ethics Committee on human research at our institution approved the collection and review of these data.

Conflict of interest

Drs. Cortez-Dias and Sousa received travel and consulting fees from Biosense Webster, Boston Scientific and Abott Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclosure.

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Brito, J., Cortez-Dias, N., da Silva, G.L. et al. Association between the number of altered late potential criteria and increased arrhythmic risk in Brugada syndrome patients. J Interv Card Electrophysiol (2023). https://doi.org/10.1007/s10840-023-01685-8

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