Patients with drug-induced type 1 Brugada electrocardiograms (BrECGs) are considered
to have good prognosis. Spontaneous type 1 is, instead, considered a risk factor;
however, it is probably underestimated because of the BrECG fluctuations. The aim
of this study was to analyze, in a large population of patients with Br, the real
prevalence of type 1 BrECG using 12-lead 24-hour Holter monitoring (12L-Holter) and
its correlation with the time of the day. We recorded 303 12L-Holter in 251 patients.
Seventy-five (30%) patients exhibited spontaneous type 1 BrECG at 12-lead ECG (group
1) and 176 (70%) had only drug-induced type 1 (group 2). Type 1 BrECG was defined
as “persistent” (>85% of the recording), “intermittent” (<85%), or “absent.” In group
1, 12% showed persistent type 1 at 12L-Holter, 57% intermittent type 1%, and 31% never
had type 1; in group 2, none had persistent type 1, 20% had intermittent type 1%,
and 80% never showed type 1. To evaluate the circadian fluctuations of BrECG, 4 periods
in the day were considered. Type 1 BrECG was more frequent between 12-noon and 6 p.m. (52%, p <0.001). In conclusion, in patients with drug-induced type 1, spontaneous
type 1 BrECG can be detected more frequently with 12L-Holter than with conventional
follow-up with periodic ECGs and this has important implications in the risk stratification.
12L-Holter recording might avoid 20% of the pharmacological challenges with sodium
channel blockers, which are not without risks, and should thus be considered as the
first screening test, particularly in children or in presence of borderline diagnostic
basal ECG.
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Article info
Publication history
Published online: October 13, 2014
Accepted:
October 5,
2014
Received in revised form:
October 5,
2014
Received:
August 20,
2014
Footnotes
The authors Drs. Cerrato and Giustetto contributed equally to the study.
This work was supported by the PRIN grant, 2010BWY8E9_006, of the Ministero Italiano dell’Istruzione, dell’Università e della Ricerca.
See page 55 for disclosure information.
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