Discrimination of Brugada Syndrome Patients From Individuals With the Saddle-Back Type ST-Segment Elevation Using a Marker of the Standard 12-Lead Electrocardiography

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Background In the clinical situation, the saddle-back (S-B) type is more frequently detected than the coved type. In the present study, the discrimination of Brugada syndrome from the S-B type individuals using a marker of the standard 12-lead electrocardiography (ECG) was attempted. Methods and Results The study group consisted of 55 individuals with the S-B type in whom pilsicainide provocation test (PLC test) was carried out. The time from the onset of the QRS wave in lead V₂ (IV ₂) to the peak of the late R-like wave in the QRS wave (PV₂), and the time from IV₂ to the offset of the QRS wave in lead V₅ (EV₅) were measured. The coved type was induced by the PLC test in 29 cases (N-C group), but not in the remaining 26 cases (N-N group). The (IV₂ -PV₂) - (IV₂ - EV₅) value before the PLS test was greater in the N-C group than in the N-N group. The negative predictive value of `(IV<sub>2</sub> - PV<sub>2</sub>) - (IV<sub>2</sub> - EV<sub>5</sub>) ≥0' was 76.4% for the prediction of a positive PLC test. Conclusions A `(IV₂ - PV₂) - (IV₂ - EV₅) ≥0' is a useful ECG marker for the discrimination of Brugada syndrome in the S-B type individuals. (Circ J 2007; 71: 546 - 549)