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Abstract：
OBJECTIVE: Brugada syndrome (BrS) diagnosis and risk stratification rely on the presence of a spontaneous type 1 (spT1) electrocardiogram (ECG) pattern; however, its spontaneous fluctuations may lead to misdiagnosis and risk underestimation. This study aims to assess the role for repeat high precordial lead (HPL) resting and ambulatory ECG monitoring in identifying a spT1, and evaluate its prognostic role.
RESULTS: HPL resting and ambulatory monitoring ECGs of BrS subjects were reviewed retrospectively, and the presence of a spT1 associated with ventricular dysrhythmias and sudden cardiac death (SCD). Three-hundred and fifty-eight subjects (77 with spT1 pattern at presentation, Group 1, and 281 without, Group 2) were included. In total, 1651 resting HPL resting and 621 ambulatory monitoring ECGs were available for review, or adequately described. Over a median follow-up of 72 months (interquartile range - IQR - 75), 42/77 (55%) subjects in Group 1 showed a spT1 in at least one ECG. In Group 2, 36/281 subjects (13%) had a newly detected spT1 (1.9 per 100 person-year) and 23 on an HPL ambulatory recording (8%). Seven previously asymptomatic subjects, five of whom had a spT1 (four at presentation and one at follow-up), experienced arrhythmic events; survival analysis indicated that a spT1, either at presentation or during lifetime, was associated with events. Univariate models showed that a spT1 was consistently associated with increased risk [spT1 at presentation: hazard ratio (HR) 6.3, 95% confidence interval (CI) 1.4-28, P = 0.016; spT1 at follow-up: HR 3.1, 95% CI 1.3-7.2, P = 0.008].
CONCLUSIONS: Repeated ECG evaluation and HPL ambulatory monitoring are vital in identifying transient spT1 Brugada pattern and its associated risk.
RESULTS: HPL resting and ambulatory monitoring ECGs of BrS subjects were reviewed retrospectively, and the presence of a spT1 associated with ventricular dysrhythmias and sudden cardiac death (SCD). Three-hundred and fifty-eight subjects (77 with spT1 pattern at presentation, Group 1, and 281 without, Group 2) were included. In total, 1651 resting HPL resting and 621 ambulatory monitoring ECGs were available for review, or adequately described. Over a median follow-up of 72 months (interquartile range - IQR - 75), 42/77 (55%) subjects in Group 1 showed a spT1 in at least one ECG. In Group 2, 36/281 subjects (13%) had a newly detected spT1 (1.9 per 100 person-year) and 23 on an HPL ambulatory recording (8%). Seven previously asymptomatic subjects, five of whom had a spT1 (four at presentation and one at follow-up), experienced arrhythmic events; survival analysis indicated that a spT1, either at presentation or during lifetime, was associated with events. Univariate models showed that a spT1 was consistently associated with increased risk [spT1 at presentation: hazard ratio (HR) 6.3, 95% confidence interval (CI) 1.4-28, P = 0.016; spT1 at follow-up: HR 3.1, 95% CI 1.3-7.2, P = 0.008].
CONCLUSIONS: Repeated ECG evaluation and HPL ambulatory monitoring are vital in identifying transient spT1 Brugada pattern and its associated risk.
摘要：
目的：Brugada综合征（BrS）的诊断和危险分层依赖于自发性1型（spT1）心电图（ECG）模式的存在；然而，其自发波动可能导致误诊和风险低估。这项研究旨在评估重复高心前导联（HPL）静息和动态心电图监测在识别spT1中的作用，并评估其预后作用。
结果：对BrS受试者的HPL静息和动态监测心电图进行回顾性回顾，以及与室性心律失常和心源性猝死（SCD）相关的spT1的存在。三百五十八名受试者(77名在演示时具有spT1模式，第一组和281，没有，包括第2组）。总的来说,1651个静息HPL静息和621个动态监测心电图可供审查，或充分描述。在72个月的中位随访时间（四分位间距-IQR-75），第1组中的42/77(55%)受试者在至少一个ECG中显示spT1。在第2组中，有36/281名受试者（13％）新检测到spT1（每100人年1.9），在HPL门诊记录中有23名（8％）。七个以前无症状的受试者，其中5人患有spT1(4人在演示中，1人在随访中)，经历过的心律失常事件；生存分析表明spT1，无论是在出现时还是在一生中，与事件有关。单变量模型显示，spT1与风险增加一致相关[spT1出现时：风险比（HR）6.3，95％置信区间（CI）1.4-28，P=0.016；spT1随访时：HR3.1，95％CI1.3-7.2，P=0.008]。
结论：重复的ECG评估和HPL动态监测对于识别短暂性spT1Brugada模式及其相关风险至关重要。
结果：对BrS受试者的HPL静息和动态监测心电图进行回顾性回顾，以及与室性心律失常和心源性猝死（SCD）相关的spT1的存在。三百五十八名受试者(77名在演示时具有spT1模式，第一组和281，没有，包括第2组）。总的来说,1651个静息HPL静息和621个动态监测心电图可供审查，或充分描述。在72个月的中位随访时间（四分位间距-IQR-75），第1组中的42/77(55%)受试者在至少一个ECG中显示spT1。在第2组中，有36/281名受试者（13％）新检测到spT1（每100人年1.9），在HPL门诊记录中有23名（8％）。七个以前无症状的受试者，其中5人患有spT1(4人在演示中，1人在随访中)，经历过的心律失常事件；生存分析表明spT1，无论是在出现时还是在一生中，与事件有关。单变量模型显示，spT1与风险增加一致相关[spT1出现时：风险比（HR）6.3，95％置信区间（CI）1.4-28，P=0.016；spT1随访时：HR3.1，95％CI1.3-7.2，P=0.008]。
结论：重复的ECG评估和HPL动态监测对于识别短暂性spT1Brugada模式及其相关风险至关重要。
