• Hsinyu Tseng, Mu-Ying Kuo, Chia-Chi Chu, Chiu-Ling Lai, Chu-Chun Huang, Hsiao-Ni Yan, and Jimmy Jyh-Ming Juang.
• Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine National Taiwan University Taipei, Taiwan. Electronic address: b97401042@gmail.com.
• J Formos Med Assoc. 2024 Dec 10.

BackgroundDiagnosis of Brugada syndrome (BrS) is based on type 1 morphology (coved type) in electrocardiograms from standard (4th) or higher (2nd or 3rd) intercostal spaces (ICSs). However, the clinical implications of being diagnosed only at higher ICSs remains poorly understood. We aimed to investigate the diagnostic accuracy of higher ICS leads in the Taiwanese Brugada syndrome population and clarify if there is any difference in clinical presentation.MethodPatients enrolled in the Sudden Arrhythmic Death Syndrome-Taiwan (SADS-TW) registry from 2010/01/01 to 2021/07/30 were retrospectively reviewed. Records were examined for 163 patients whose ECGs in the 2nd, 3rd, and/or 4th ICSs showed a type 1 BrS pattern in at least 1 lead. Baseline characteristics, family history, clinical presentation, SCN5A mutation status, cardiovascular events, and mortality were analyzed.ResultUsing the standard ICS alone, 56.4% patients could be diagnosed with BrS, whereas the remaining 43.6% of patients could only be diagnosed using higher ICSs. The mean age of diagnosis using higher ICSs was 42.2 ± 14.7 years vs. 46.8 ± 14.6 years in patients diagnosed using the standard ICSs (p = 0.048). Hypertension was more prevalent in patients diagnosed by standard ICSs (27.2%) vs. patients diagnosed by higher ICSs (4.2%; p < 0.001). No differences were observed in family history, clinical presentation, SCN5A mutation status, cardiovascular events, or mortality (mean follow-up time = 3.96 ± 3.45 years, p = 0.28).ConclusionUsing higher intercostal leads could significantly increase the diagnosis rate of BrS in the Taiwanese population, although it would not affect the clinical prognosis.Copyright © 2024 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.

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