Evaluation of a new treadmill exercise protocol to unmask type 1 Brugada electrocardiographic pattern: can we improve diagnostic yield?
Abstract Aims High precordial leads (HPL) on the resting electrocardiogram (ECG) are widely used to improve diagnostic detection of type 1 Brugada ECG pattern (Br1ECGp). A parasympathetic activation marks the initial recovery phase of treadmill stress testing (TET), and this can be useful for detect...
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| Veröffentlicht in: | Europace (London, England) England), 2023-07, Vol.25 (7) |
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| creator | Pichara, Nemer L Sacilotto, Luciana Scanavacca, Maurício I Cardoso, Acácio Fernandes Soares, Beatriz Moreira Ayub Ferreira Falcochio, Paola P PN F Falcão, Andrea M G Olivetti, Natalia da Costa Darrieux, Francisco Carlos Chalela, William A |
| description | Abstract
Aims
High precordial leads (HPL) on the resting electrocardiogram (ECG) are widely used to improve diagnostic detection of type 1 Brugada ECG pattern (Br1ECGp). A parasympathetic activation marks the initial recovery phase of treadmill stress testing (TET), and this can be useful for detecting the typical ECG pattern. Our study aimed to evaluate the role of a new HPL-treadmill exercise testing (TET) protocol in detecting Br1ECGp fluctuation compared to resting HPL-ECG.
Methods and results
74 out of 163 patients of a Brugada syndrome (BrS) Brazilian cohort (GenBra Registry) underwent exercise testing with HPL-TET protocol. Precordial leads were displayed in strategic positions in the right and left parasternal spaces. The step-by-step analysis included ECG classification (as presence or absence of Br1ECGp) in standard vs. HPL leads placement in the following sequences: resting phase, maximal exercise, and the passive recovery phase (including ‘quick lay down’). For heart rate recovery (HRR) measurements and comparisons, a Student’s t-test was applied. McNemar tests compared the detection of Br1ECGp. The significance level was defined as P < 0.05. Fifty-seven patients (57/74; 77%) were male, the mean age was 49.0 ± 14, 78.4% had spontaneous BrS, and the mean Shanghai score was 4.5. The HPL-TET protocol increased Br1ECGp detection by 32.4% against resting HPL-ECG (52.7% vs. 20.3%, P = 0.001) alone.
Conclusion
Stress testing using HPL with the passive recovery phase in the supine position offers an opportunity to unmask the type 1 Br1ECGp, which could increase the diagnostic yield in this population.
Graphical Abstract
Graphical abstract |
| doi_str_mv | 10.1093/europace/euad157 |
| format | Article |
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Aims
High precordial leads (HPL) on the resting electrocardiogram (ECG) are widely used to improve diagnostic detection of type 1 Brugada ECG pattern (Br1ECGp). A parasympathetic activation marks the initial recovery phase of treadmill stress testing (TET), and this can be useful for detecting the typical ECG pattern. Our study aimed to evaluate the role of a new HPL-treadmill exercise testing (TET) protocol in detecting Br1ECGp fluctuation compared to resting HPL-ECG.
Methods and results
74 out of 163 patients of a Brugada syndrome (BrS) Brazilian cohort (GenBra Registry) underwent exercise testing with HPL-TET protocol. Precordial leads were displayed in strategic positions in the right and left parasternal spaces. The step-by-step analysis included ECG classification (as presence or absence of Br1ECGp) in standard vs. HPL leads placement in the following sequences: resting phase, maximal exercise, and the passive recovery phase (including ‘quick lay down’). For heart rate recovery (HRR) measurements and comparisons, a Student’s t-test was applied. McNemar tests compared the detection of Br1ECGp. The significance level was defined as P < 0.05. Fifty-seven patients (57/74; 77%) were male, the mean age was 49.0 ± 14, 78.4% had spontaneous BrS, and the mean Shanghai score was 4.5. The HPL-TET protocol increased Br1ECGp detection by 32.4% against resting HPL-ECG (52.7% vs. 20.3%, P = 0.001) alone.
Conclusion
Stress testing using HPL with the passive recovery phase in the supine position offers an opportunity to unmask the type 1 Br1ECGp, which could increase the diagnostic yield in this population.
Graphical Abstract
Graphical abstract</description><identifier>ISSN: 1099-5129</identifier><identifier>EISSN: 1532-2092</identifier><identifier>DOI: 10.1093/europace/euad157</identifier><identifier>PMID: 37410808</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Brazil ; Brugada Syndrome - diagnosis ; China ; Clinical Research ; Electrocardiography - methods ; Exercise Test ; Female ; Humans ; Male</subject><ispartof>Europace (London, England), 2023-07, Vol.25 (7)</ispartof><rights>The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. 2023</rights><rights>The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c433t-4d77304b1084cae6ffc8a84c54ce46bc4524b2461c8fa97a22408b2045c9d1c43</citedby><cites>FETCH-LOGICAL-c433t-4d77304b1084cae6ffc8a84c54ce46bc4524b2461c8fa97a22408b2045c9d1c43</cites><orcidid>0000-0001-7175-3593 ; 0009-0000-5203-3312 ; 0000-0003-2333-2828 ; 0000-0003-1061-8982 ; 0000-0001-7327-2275 ; 0000-0002-4613-4181 ; 0000-0001-5818-5958 ; 0000-0002-3679-5349 ; 0009-0002-4835-9285 ; 0000-0003-3751-0728</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10325004/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10325004/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,1598,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37410808$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pichara, Nemer L</creatorcontrib><creatorcontrib>Sacilotto, Luciana</creatorcontrib><creatorcontrib>Scanavacca, Maurício I</creatorcontrib><creatorcontrib>Cardoso, Acácio Fernandes</creatorcontrib><creatorcontrib>Soares, Beatriz Moreira Ayub Ferreira</creatorcontrib><creatorcontrib>Falcochio, Paola P PN F</creatorcontrib><creatorcontrib>Falcão, Andrea M G</creatorcontrib><creatorcontrib>Olivetti, Natalia</creatorcontrib><creatorcontrib>da Costa Darrieux, Francisco Carlos</creatorcontrib><creatorcontrib>Chalela, William A</creatorcontrib><title>Evaluation of a new treadmill exercise protocol to unmask type 1 Brugada electrocardiographic pattern: can we improve diagnostic yield?</title><title>Europace (London, England)</title><addtitle>Europace</addtitle><description>Abstract
Aims
High precordial leads (HPL) on the resting electrocardiogram (ECG) are widely used to improve diagnostic detection of type 1 Brugada ECG pattern (Br1ECGp). A parasympathetic activation marks the initial recovery phase of treadmill stress testing (TET), and this can be useful for detecting the typical ECG pattern. Our study aimed to evaluate the role of a new HPL-treadmill exercise testing (TET) protocol in detecting Br1ECGp fluctuation compared to resting HPL-ECG.
Methods and results
74 out of 163 patients of a Brugada syndrome (BrS) Brazilian cohort (GenBra Registry) underwent exercise testing with HPL-TET protocol. Precordial leads were displayed in strategic positions in the right and left parasternal spaces. The step-by-step analysis included ECG classification (as presence or absence of Br1ECGp) in standard vs. HPL leads placement in the following sequences: resting phase, maximal exercise, and the passive recovery phase (including ‘quick lay down’). For heart rate recovery (HRR) measurements and comparisons, a Student’s t-test was applied. McNemar tests compared the detection of Br1ECGp. The significance level was defined as P < 0.05. Fifty-seven patients (57/74; 77%) were male, the mean age was 49.0 ± 14, 78.4% had spontaneous BrS, and the mean Shanghai score was 4.5. The HPL-TET protocol increased Br1ECGp detection by 32.4% against resting HPL-ECG (52.7% vs. 20.3%, P = 0.001) alone.
Conclusion
Stress testing using HPL with the passive recovery phase in the supine position offers an opportunity to unmask the type 1 Br1ECGp, which could increase the diagnostic yield in this population.
Graphical Abstract
Graphical abstract</description><subject>Brazil</subject><subject>Brugada Syndrome - diagnosis</subject><subject>China</subject><subject>Clinical Research</subject><subject>Electrocardiography - methods</subject><subject>Exercise Test</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><issn>1099-5129</issn><issn>1532-2092</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><sourceid>EIF</sourceid><recordid>eNqFkU1v1DAQhi0EoqVw54R8REIB27E3MZcKqvIhVeICZ2tiT7YGJw62s2V_AX8bV7ut4MTJr-RnnhnpJeQ5Z6850-0bXFNcwGIN4LjqHpBTrlrRCKbFw5qZ1o3iQp-QJzl_Z4x1QqvH5KTtJGc960_J78sdhBWKjzONIwU64w0tCcFNPgSKvzBZn5EuKZZoY6Al0nWeIP-gZb8g5fR9WrfggGJAW1K0kJyP2wTLtbd0gVIwzW-phZneIPVTFe2QOg_bOeZSkb3H4M6fkkcjhIzPju8Z-fbh8uvFp-bqy8fPF--uGivbtjTSdV3L5FCvlxZwM462hxqVtCg3g5VKyEHIDbf9CLoDISTrB8Gkstrx6jgj5wfvsg4TOotzSRDMkvwEaW8iePPvz-yvzTbuDGetUIzdGl4eDSn-XDEXM_lsMQSYMa7ZiL5VohOS64qyA2pTzDnheL-HM3NboLkr0BwLrCMv_r7vfuCusQq8OgBxXf6v-wOuhqz-</recordid><startdate>20230704</startdate><enddate>20230704</enddate><creator>Pichara, Nemer L</creator><creator>Sacilotto, Luciana</creator><creator>Scanavacca, Maurício I</creator><creator>Cardoso, Acácio Fernandes</creator><creator>Soares, Beatriz Moreira Ayub Ferreira</creator><creator>Falcochio, Paola P PN F</creator><creator>Falcão, Andrea M G</creator><creator>Olivetti, Natalia</creator><creator>da Costa Darrieux, Francisco Carlos</creator><creator>Chalela, William A</creator><general>Oxford University Press</general><scope>TOX</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-7175-3593</orcidid><orcidid>https://orcid.org/0009-0000-5203-3312</orcidid><orcidid>https://orcid.org/0000-0003-2333-2828</orcidid><orcidid>https://orcid.org/0000-0003-1061-8982</orcidid><orcidid>https://orcid.org/0000-0001-7327-2275</orcidid><orcidid>https://orcid.org/0000-0002-4613-4181</orcidid><orcidid>https://orcid.org/0000-0001-5818-5958</orcidid><orcidid>https://orcid.org/0000-0002-3679-5349</orcidid><orcidid>https://orcid.org/0009-0002-4835-9285</orcidid><orcidid>https://orcid.org/0000-0003-3751-0728</orcidid></search><sort><creationdate>20230704</creationdate><title>Evaluation of a new treadmill exercise protocol to unmask type 1 Brugada electrocardiographic pattern: can we improve diagnostic yield?</title><author>Pichara, Nemer L ; Sacilotto, Luciana ; Scanavacca, Maurício I ; Cardoso, Acácio Fernandes ; Soares, Beatriz Moreira Ayub Ferreira ; Falcochio, Paola P PN F ; Falcão, Andrea M G ; Olivetti, Natalia ; da Costa Darrieux, Francisco Carlos ; Chalela, William A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c433t-4d77304b1084cae6ffc8a84c54ce46bc4524b2461c8fa97a22408b2045c9d1c43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Brazil</topic><topic>Brugada Syndrome - diagnosis</topic><topic>China</topic><topic>Clinical Research</topic><topic>Electrocardiography - methods</topic><topic>Exercise Test</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pichara, Nemer L</creatorcontrib><creatorcontrib>Sacilotto, Luciana</creatorcontrib><creatorcontrib>Scanavacca, Maurício I</creatorcontrib><creatorcontrib>Cardoso, Acácio Fernandes</creatorcontrib><creatorcontrib>Soares, Beatriz Moreira Ayub Ferreira</creatorcontrib><creatorcontrib>Falcochio, Paola P PN F</creatorcontrib><creatorcontrib>Falcão, Andrea M G</creatorcontrib><creatorcontrib>Olivetti, Natalia</creatorcontrib><creatorcontrib>da Costa Darrieux, Francisco Carlos</creatorcontrib><creatorcontrib>Chalela, William A</creatorcontrib><collection>Oxford Journals Open Access Collection</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Europace (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pichara, Nemer L</au><au>Sacilotto, Luciana</au><au>Scanavacca, Maurício I</au><au>Cardoso, Acácio Fernandes</au><au>Soares, Beatriz Moreira Ayub Ferreira</au><au>Falcochio, Paola P PN F</au><au>Falcão, Andrea M G</au><au>Olivetti, Natalia</au><au>da Costa Darrieux, Francisco Carlos</au><au>Chalela, William A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation of a new treadmill exercise protocol to unmask type 1 Brugada electrocardiographic pattern: can we improve diagnostic yield?</atitle><jtitle>Europace (London, England)</jtitle><addtitle>Europace</addtitle><date>2023-07-04</date><risdate>2023</risdate><volume>25</volume><issue>7</issue><issn>1099-5129</issn><eissn>1532-2092</eissn><abstract>Abstract
Aims
High precordial leads (HPL) on the resting electrocardiogram (ECG) are widely used to improve diagnostic detection of type 1 Brugada ECG pattern (Br1ECGp). A parasympathetic activation marks the initial recovery phase of treadmill stress testing (TET), and this can be useful for detecting the typical ECG pattern. Our study aimed to evaluate the role of a new HPL-treadmill exercise testing (TET) protocol in detecting Br1ECGp fluctuation compared to resting HPL-ECG.
Methods and results
74 out of 163 patients of a Brugada syndrome (BrS) Brazilian cohort (GenBra Registry) underwent exercise testing with HPL-TET protocol. Precordial leads were displayed in strategic positions in the right and left parasternal spaces. The step-by-step analysis included ECG classification (as presence or absence of Br1ECGp) in standard vs. HPL leads placement in the following sequences: resting phase, maximal exercise, and the passive recovery phase (including ‘quick lay down’). For heart rate recovery (HRR) measurements and comparisons, a Student’s t-test was applied. McNemar tests compared the detection of Br1ECGp. The significance level was defined as P < 0.05. Fifty-seven patients (57/74; 77%) were male, the mean age was 49.0 ± 14, 78.4% had spontaneous BrS, and the mean Shanghai score was 4.5. The HPL-TET protocol increased Br1ECGp detection by 32.4% against resting HPL-ECG (52.7% vs. 20.3%, P = 0.001) alone.
Conclusion
Stress testing using HPL with the passive recovery phase in the supine position offers an opportunity to unmask the type 1 Br1ECGp, which could increase the diagnostic yield in this population.
Graphical Abstract
Graphical abstract</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>37410808</pmid><doi>10.1093/europace/euad157</doi><orcidid>https://orcid.org/0000-0001-7175-3593</orcidid><orcidid>https://orcid.org/0009-0000-5203-3312</orcidid><orcidid>https://orcid.org/0000-0003-2333-2828</orcidid><orcidid>https://orcid.org/0000-0003-1061-8982</orcidid><orcidid>https://orcid.org/0000-0001-7327-2275</orcidid><orcidid>https://orcid.org/0000-0002-4613-4181</orcidid><orcidid>https://orcid.org/0000-0001-5818-5958</orcidid><orcidid>https://orcid.org/0000-0002-3679-5349</orcidid><orcidid>https://orcid.org/0009-0002-4835-9285</orcidid><orcidid>https://orcid.org/0000-0003-3751-0728</orcidid><oa>free_for_read</oa></addata></record> |
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| language | eng |
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| source | Oxford Journals Open Access Collection; MEDLINE; PubMed Central; Alma/SFX Local Collection; EZB Electronic Journals Library |
| subjects | Brazil Brugada Syndrome - diagnosis China Clinical Research Electrocardiography - methods Exercise Test Female Humans Male |
| title | Evaluation of a new treadmill exercise protocol to unmask type 1 Brugada electrocardiographic pattern: can we improve diagnostic yield? |
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