EKG Marker of Sudden Death in Brugada Syndrome Identified

MedicalResearch.com Interview with:
Leonardo Calo’, MD, FESC and Annamaria Martino, MD

Policlinico Caslino, Rome, Italy

MedicalResearch.com: What is the background for this study

Response: Brugada syndrome is a genetic syndrome associated to an increased risk of sudden cardiac death. For years, dispersion of repolarization within the right ventricle has been considered the cause of arrhythmogenesis in Brugada syndrome. However, recent studies have suggested that the pathophysiologic basis of this syndrome is a conduction delay in the right ventricular outflow tract.

The risk stratification of sudden cardiac death in patients affected by Brugada syndrome, especially those who are asymptomatic, is unclear. An S wave in lead I reflects the depolarization of the right ventricular outflow tract, and appears to be prominent when right ventricular enlargement and fibrosis are present (i.e in cor pulmonale or congenital cardiac diseases). Therefore we aimed at verify whether, a prominent S in DI lead could identify Brugada syndrome patients at risk of sudden cardiac death.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: The presence of a wide and/or large S wave in lead I, reflecting fibrosis and delayed activation in the right ventricle outflow tract, is a marker of increased risk of ventricular arrhythmias in patients with Brugada syndrome.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Future studies should confirm the presence of increased fibrosis in the right ventricular outflow tract in patients with Brugada syndrome with a prominent S wave in DI lead. This could be verified by systematic assessement of the right ventricle with magnetic resonance imaging (eventually through T1 mapping sequences) and high density epicardial and endocardial electroanatomic mapping.

Moreover, it could be interesting to evaluate eventual distribution of a prominent S wave in lead DI among members affected by Brugada syndrome of the same family, possibly reflecting specific genetic mutation involved in fibrosis of the right ventricle.

MedicalResearch.com: Is there anything else you would like to add?

Response: A prominent S wave in lead DI has demonstrated to be a powerful predictor of sudden cardiac death in Brugada syndrome. However, it should probably be implemented within multiparametrical models for risk stratification in Brugada syndrome.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.


Calò L, Giustetto C, Martino A, et al. A New Electrocardiographic Marker of Sudden Death in Brugada Syndrome: The S-Wave in Lead I. J Am Coll Cardiol. 2016;67(12):1427-1440. doi:10.1016/j.jacc.2016.01.024.

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