Usefulness of the R wave Sign as a Predictor for Ventricular Tachyarrhythmia in Patients with Brugada Syndrome

• Published in: The American journal of cardiology 2017-08, Vol.120 (3), p.428-434
• Main Authors: Ragab, Ahmed A.Y., MBBCh, Houck, Charlotte A., BSc, van der Does, Lisette J.M.E., MD, Lanters, Eva A.H., MD, Burghouwt, Danielle E., BSc, Muskens, Agnes J.Q.M., RN, de Groot, Natasja M.S., MD, PhD
• Format: Article
• Language: English
• Subjects: Abnormalities; Adult; Brugada Syndrome - complications; Brugada Syndrome - diagnosis; Brugada Syndrome - physiopathology; Cardiac arrhythmia; Cardiovascular; Channelopathy; Conduction; Confidence intervals; Death, Sudden, Cardiac - epidemiology; Electrocardiography; Family medical history; Female; Follow-Up Studies; Heart; Heart diseases; Heart Ventricles - physiopathology; Humans; Incidence; Male; Medical records; Men; Middle Aged; Morphology; Mutation; Netherlands - epidemiology; Patients; Regression analysis; Retrospective Studies; Risk; Risk Assessment; Risk groups; Risk management; ROC Curve; Survival Rate - trends; Syncope; Tachyarrhythmia; Tachycardia, Ventricular - diagnosis; Tachycardia, Ventricular - etiology; Tachycardia, Ventricular - physiopathology; Ventricle
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2017.04.044

Abstract Brugada syndrome (BrS) is an autosomal dominant channelopathy which is responsible for a large number of sudden cardiac deaths in young individuals without structural abnormalities. The most challenging step in management of patients with BrS is identifying who is at risk for developing malignant ventricular tachyarrhythmia (VTA). In patients with BrS, conduction delay in the right ventricular outflow tract (RVOT) causes a prominent R wave in lead aVR. This electrocardiographic parameter can be useful to detect these high risk patients. The goal of this study is to test the significance of R wave elevation in lead aVR as a predictor for VTA in patients with BrS. In this retrospective study, we included 132 patients with BrS (47±15 years, 65% male) who visited the outpatient clinic for cardiogenetic screening. Patients’ medical records were examined for the presence of a positive R wave sign in lead aVR and VTA. A positive R wave sign in lead aVR was observed in 41 patients (31%). This sign was more frequently observed in patients who experienced VTA (N=24) either before the initial diagnosis, during electrophysiological studies or during follow up (P < 0.001). The positive R wave sign occurred more frequently in symptomatic patients with a history of an out of hospital cardiac arrest, VTA or syncope, than asymptomatic patients (60% versus 26%; P = 0.002). During the follow up period, this sign was more frequently detected in patients who developed either de novo (50%) or recurrent (80%) VTA (P = 0.017). Multivariable regression analysis showed that R wave sign is an independent predictor for VTA development (OR 4.8, 95% CI 1.79-13.27). The presence of a positive R wave sign in lead aVR is associated with development of VTA. In conclusion, positive R wave sign in lead aVR can be used to identify BrS patients at risk for malignant VTA.