Clinical significance of inferolateral early repolarisation and late potentials in children with Brugada Syndrome

• Published in: Journal of electrocardiology 2021-05, Vol.66, p.79-83
• Main Authors: Lopez-Blazquez, Maria, Field, Ella, Tollit, Jennifer, Walsh, Helen, Addis, Amy, French, Nichola, Starling, Luke, Kaski, Juan Pablo
• Format: Article
• Language: English
• Subjects: Ajmaline testing; Arrhythmic risk; Brugada Syndrome; Cardiac arrhythmia; Children & youth; Clinical outcomes; Clinical significance; Electrocardiography; Fractioned QRS; Heart attacks; Inferolateral early repolarisation; Late potentials; Sudden cardiac death
• ISSN: 0022-0736; 1532-8430
• DOI: 10.1016/j.jelectrocard.2021.03.011

The clinical utility of inferolateral early repolarisation (ER) and late potentials (LP) in children with Brugada Syndrome (BrS) has not been previously evaluated. The aim of this study was to determine the prevalence of electrocardiographic (ECG) abnormalities in children with BrS, and to investigate their relationship with clinical outcomes. 43 patients with BrS and 47 controls aged ≤18 undergoing systematic clinical and ECG evaluation, including signal-averaged ECG (SAECG) and pharmacological provocation testing, between 2003 and 2019 were included. Four patients with BrS (9%) presented with a spontaneous type 1 Brugada pattern; the remaining 39 (91%) were diagnosed following ajmaline provocation testing. Twelve BrS patients (28%) had late potentials (LP) on SAECG compared to 1 (2%) in controls (p = 0.001). LP were more common in 5 patients with a high-risk phenotype (60% vs 24%) but this was not statistically significant. Twelve patients with BrS (28%) had inferolateral early repolarisation (ER) and 2 (5%) had fractionated QRS (f-QRS), but there were no statistically-significant differences with controls in these parameters. A significant arrhythmia (non-sustained ventricular tachycardia or atrial fibrillation) was seen in 4 patients (9%). This study shows a high prevalence of SAECG abnormalities in children with BrS compared with controls, but this was not significantly associated with a high-risk phenotype. •Depolarization and repolarization abnormalities have not been previously evaluated in children•Our study shows a high prevalence of late potentials on SAECG and inferolateral early repolarization in children with BrS, but these were not associated with increased arrhythmic risk•The findings suggest that different risk factors may be important in paediatric BrS compared to adults