Relationship Between ST-Segment Morphology and Conduction Disturbances Detected by Signal-Averaged Electrocardiography in Brugada Syndrome

Background: Although arrhythmogenesis of Brugada syndrome is still unknown, it has been reported to be associated with conduction disturbances. Two ST‐segment morphologies (coved and saddle‐back patterns) have been described in this syndrome. No study has sought to determine which morphology has stronger conduction disturbances, thereby associating with life‐threatening events. Methods: Forty‐six patients who presented the Brugada‐type ECG with either of a characteristic coved (n = 25) or saddle‐back (n = 21) pattern of ST‐segment morphology underwent signal‐averaged ECG (SAECG). SAECG parameters, and the history of life‐threatening events defined as syncope or aborted sudden death, were compared between groups. Results: Although filtered QRS duration did not differ between groups, the incidence of late potentials in the coved group was higher than in the saddle‐back group (22 patients (88%) versus 4 patients (19%); P < 0.01), showing lower RMS40 and longer LAS40. Life‐threatening events occurred in 17 patients (68%) in the coved group and 7 patients (33%) in the saddle‐back group (P = 0.02). Conclusion: The coved pattern of ST segment was more closely related to conduction disturbances than the saddle‐back pattern in patients with Brugada‐type ECG. Life‐threatening events were more common in patients with the coved ST‐segment elevation. Conduction disturbances in the coved pattern of ST segment may reflect a substrate of arrhythmogenesis in Brugada syndrome.