Evaluation of baseline ECG in patients undergoing Oral Flecainide Challenge test for suspected Brugada Syndrome: An analysis of lead II

Maneesh K. Rai, Mukund A. Prabhu, Jayaprakash Shenthar, Natarajan Kumaraswamy U, Ritesh Vekariya, Padmanabh Kamath, Narasimha Pai, Ramanath L. Kamath, Vivek Pillai

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background and Objectives We analyzed Lead II in patients undergoing an Oral Flecainide Challenge test (FCT), to identify any pointers that could predict a positive FCT and thereby help in recognition of latent BS. Methods The following parameters in lead II were retrospectively analyzed from the pre-test ECG in 62 patients undergoing FCT for suspected BS: The presence or absence of S waves, S wave amplitude, duration and upslope duration; J point parameters- Early repolarization, QRS notch, and QRS Slur; ST segment parameters-lack of isoelectric ST segment, ST duration and QT interval. Results 48 had positive FCT (Group-1) while 14 were negative for FCT(Group-2). Lack of an isoelectric ST segment (50% vs 14.29%, p = 0.018) and slurring of QRS (33.33% vs 0%, p = 0.014) was more common in Group-1 than Group-2. Group-1 had shorter ST segment duration (median 81.5 (IQR 64–103.5) vs 110 (IQR 90–132), p = 0.002) and shorter ST: QT ratio (median 0.28 (IQR 0.22–0.35) vs 0.23 (0.18–0.27), p = 0.007). QRS notch/depressed J point (87.5%), QRS slur (100%), and lack of isoelectric ST segment (92.31%) had high sensitivity for predicting an inducible Type 1 Brugada pattern. Combining two parameters- ST: QT ratio<0.24 and lack of isoelectric ST segment-considerably improved the specificity (73.3%), and the positive predictive value of the test to 76%. The results remained accurate when validated in a small prospective cohort. Conclusion Shortened ST segment in Lead II, lack of isoelectric ST segment, slurred QRS and ST/QT ratio <0.24 are predictive of underlying Brugada pattern in baseline ECG.

Original languageEnglish
Pages (from-to)102-107
Number of pages6
JournalIndian Pacing and Electrophysiology Journal
Volume17
Issue number4
DOIs
Publication statusPublished - 01-07-2017

Fingerprint

Flecainide
Brugada Syndrome
Electrocardiography
Predictive Value of Tests
Lead

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Rai, Maneesh K. ; Prabhu, Mukund A. ; Shenthar, Jayaprakash ; Kumaraswamy U, Natarajan ; Vekariya, Ritesh ; Kamath, Padmanabh ; Pai, Narasimha ; Kamath, Ramanath L. ; Pillai, Vivek. / Evaluation of baseline ECG in patients undergoing Oral Flecainide Challenge test for suspected Brugada Syndrome : An analysis of lead II. In: Indian Pacing and Electrophysiology Journal. 2017 ; Vol. 17, No. 4. pp. 102-107.
@article{14e89d98752343fd8fb21a3b05b3f47d,
title = "Evaluation of baseline ECG in patients undergoing Oral Flecainide Challenge test for suspected Brugada Syndrome: An analysis of lead II",
abstract = "Background and Objectives We analyzed Lead II in patients undergoing an Oral Flecainide Challenge test (FCT), to identify any pointers that could predict a positive FCT and thereby help in recognition of latent BS. Methods The following parameters in lead II were retrospectively analyzed from the pre-test ECG in 62 patients undergoing FCT for suspected BS: The presence or absence of S waves, S wave amplitude, duration and upslope duration; J point parameters- Early repolarization, QRS notch, and QRS Slur; ST segment parameters-lack of isoelectric ST segment, ST duration and QT interval. Results 48 had positive FCT (Group-1) while 14 were negative for FCT(Group-2). Lack of an isoelectric ST segment (50{\%} vs 14.29{\%}, p = 0.018) and slurring of QRS (33.33{\%} vs 0{\%}, p = 0.014) was more common in Group-1 than Group-2. Group-1 had shorter ST segment duration (median 81.5 (IQR 64–103.5) vs 110 (IQR 90–132), p = 0.002) and shorter ST: QT ratio (median 0.28 (IQR 0.22–0.35) vs 0.23 (0.18–0.27), p = 0.007). QRS notch/depressed J point (87.5{\%}), QRS slur (100{\%}), and lack of isoelectric ST segment (92.31{\%}) had high sensitivity for predicting an inducible Type 1 Brugada pattern. Combining two parameters- ST: QT ratio<0.24 and lack of isoelectric ST segment-considerably improved the specificity (73.3{\%}), and the positive predictive value of the test to 76{\%}. The results remained accurate when validated in a small prospective cohort. Conclusion Shortened ST segment in Lead II, lack of isoelectric ST segment, slurred QRS and ST/QT ratio <0.24 are predictive of underlying Brugada pattern in baseline ECG.",
author = "Rai, {Maneesh K.} and Prabhu, {Mukund A.} and Jayaprakash Shenthar and {Kumaraswamy U}, Natarajan and Ritesh Vekariya and Padmanabh Kamath and Narasimha Pai and Kamath, {Ramanath L.} and Vivek Pillai",
year = "2017",
month = "7",
day = "1",
doi = "10.1016/j.ipej.2017.04.002",
language = "English",
volume = "17",
pages = "102--107",
journal = "Indian Pacing and Electrophysiology Journal",
issn = "0972-6292",
publisher = "Indian Pacing and Electrophysiology Group",
number = "4",

}

Evaluation of baseline ECG in patients undergoing Oral Flecainide Challenge test for suspected Brugada Syndrome : An analysis of lead II. / Rai, Maneesh K.; Prabhu, Mukund A.; Shenthar, Jayaprakash; Kumaraswamy U, Natarajan; Vekariya, Ritesh; Kamath, Padmanabh; Pai, Narasimha; Kamath, Ramanath L.; Pillai, Vivek.

In: Indian Pacing and Electrophysiology Journal, Vol. 17, No. 4, 01.07.2017, p. 102-107.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Evaluation of baseline ECG in patients undergoing Oral Flecainide Challenge test for suspected Brugada Syndrome

T2 - An analysis of lead II

AU - Rai, Maneesh K.

AU - Prabhu, Mukund A.

AU - Shenthar, Jayaprakash

AU - Kumaraswamy U, Natarajan

AU - Vekariya, Ritesh

AU - Kamath, Padmanabh

AU - Pai, Narasimha

AU - Kamath, Ramanath L.

AU - Pillai, Vivek

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Background and Objectives We analyzed Lead II in patients undergoing an Oral Flecainide Challenge test (FCT), to identify any pointers that could predict a positive FCT and thereby help in recognition of latent BS. Methods The following parameters in lead II were retrospectively analyzed from the pre-test ECG in 62 patients undergoing FCT for suspected BS: The presence or absence of S waves, S wave amplitude, duration and upslope duration; J point parameters- Early repolarization, QRS notch, and QRS Slur; ST segment parameters-lack of isoelectric ST segment, ST duration and QT interval. Results 48 had positive FCT (Group-1) while 14 were negative for FCT(Group-2). Lack of an isoelectric ST segment (50% vs 14.29%, p = 0.018) and slurring of QRS (33.33% vs 0%, p = 0.014) was more common in Group-1 than Group-2. Group-1 had shorter ST segment duration (median 81.5 (IQR 64–103.5) vs 110 (IQR 90–132), p = 0.002) and shorter ST: QT ratio (median 0.28 (IQR 0.22–0.35) vs 0.23 (0.18–0.27), p = 0.007). QRS notch/depressed J point (87.5%), QRS slur (100%), and lack of isoelectric ST segment (92.31%) had high sensitivity for predicting an inducible Type 1 Brugada pattern. Combining two parameters- ST: QT ratio<0.24 and lack of isoelectric ST segment-considerably improved the specificity (73.3%), and the positive predictive value of the test to 76%. The results remained accurate when validated in a small prospective cohort. Conclusion Shortened ST segment in Lead II, lack of isoelectric ST segment, slurred QRS and ST/QT ratio <0.24 are predictive of underlying Brugada pattern in baseline ECG.

AB - Background and Objectives We analyzed Lead II in patients undergoing an Oral Flecainide Challenge test (FCT), to identify any pointers that could predict a positive FCT and thereby help in recognition of latent BS. Methods The following parameters in lead II were retrospectively analyzed from the pre-test ECG in 62 patients undergoing FCT for suspected BS: The presence or absence of S waves, S wave amplitude, duration and upslope duration; J point parameters- Early repolarization, QRS notch, and QRS Slur; ST segment parameters-lack of isoelectric ST segment, ST duration and QT interval. Results 48 had positive FCT (Group-1) while 14 were negative for FCT(Group-2). Lack of an isoelectric ST segment (50% vs 14.29%, p = 0.018) and slurring of QRS (33.33% vs 0%, p = 0.014) was more common in Group-1 than Group-2. Group-1 had shorter ST segment duration (median 81.5 (IQR 64–103.5) vs 110 (IQR 90–132), p = 0.002) and shorter ST: QT ratio (median 0.28 (IQR 0.22–0.35) vs 0.23 (0.18–0.27), p = 0.007). QRS notch/depressed J point (87.5%), QRS slur (100%), and lack of isoelectric ST segment (92.31%) had high sensitivity for predicting an inducible Type 1 Brugada pattern. Combining two parameters- ST: QT ratio<0.24 and lack of isoelectric ST segment-considerably improved the specificity (73.3%), and the positive predictive value of the test to 76%. The results remained accurate when validated in a small prospective cohort. Conclusion Shortened ST segment in Lead II, lack of isoelectric ST segment, slurred QRS and ST/QT ratio <0.24 are predictive of underlying Brugada pattern in baseline ECG.

UR - http://www.scopus.com/inward/record.url?scp=85020137177&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85020137177&partnerID=8YFLogxK

U2 - 10.1016/j.ipej.2017.04.002

DO - 10.1016/j.ipej.2017.04.002

M3 - Article

AN - SCOPUS:85020137177

VL - 17

SP - 102

EP - 107

JO - Indian Pacing and Electrophysiology Journal

JF - Indian Pacing and Electrophysiology Journal

SN - 0972-6292

IS - 4

ER -