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CLINICAL RESEARCH

QT-interval prolongation inright precordial leads

an additional electrocardiographic hallmark of Brugada syndrome

Maria Vittoria Pitzalis, MD, PhD^*,*, Matteo Anaclerio, MD, PhD^*, Massimo Iacoviello, MD^*, Cinzia Forleo, MD, PhD^*, Pietro Guida, MS^*, Rossella Troccoli, MD^*, Francesco Massari, MD, Filippo Mastropasqua, MD, Sandro Sorrentino, PhD^*, Andrea Manghisi, MS^* and Paolo Rizzon, MD^*

^* Institute of Cardiology, University of Bari, Bari, Italy
Centre of Innovative Technologies for Signal Detection and Processing, University of Bari, Bari, Italy
Cardiology "Salvatore Maugeri" Foundation, IRCCS Cassano, Cassano, Italy

Manuscript received March 25, 2003; revised manuscript received June 6, 2003, accepted July 1, 2003.

^* Reprint requests and correspondence: Dr. Maria Vittoria Pitzalis, Institute of Cardiology-University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy.
mariavittoria.pitzalis{at}cardio.uniba.it

OBJECTIVES: The aim of this study was to evaluate whether the occurrence of the Brugada Syndrome typical electrocardiogram (ECG) pattern (i.e., right bundle branch block, coved-type ST-segment elevation, and T-wave inversion in the right precordial leads) is characterized by a concomitant lengthening of QT intervals in the right precordial leads.

BACKGROUND: It has been suggested that the typical ECG pattern of Brugada syndrome is due to a decreased net inward current during phase 1 of the action potential, which also leads to its prolongation in the right epicardium.

METHODS: Thirty-two subjects (19 males) age 37 ± 15 years with a suspicious baseline ECG, or who were relatives of Brugada syndrome patients, underwent 12-lead ECG before and after the administration of flecainide.

RESULTS: The flecainide test was negative in 14 and positive in 18 subjects. After flecainide administration, the positive ECGs were characterized by a greater QT interval corrected for heart rate (QTc) prolongation in the right precordial leads than that in the negative ECGs (78.2 ± 35.5 ms vs. 22.0 ± 28.4 ms in V₁ and 107.1 ± 43.8 ms vs. 26.7 ± 30.1 ms in V₂; p < 0.01), whereas there was no difference in the QTc prolongation in the left precordial leads (55.2 ± 25.3 ms vs. 35.1 ± 28.1 ms in V₅ and 53.1 ± 32.8 ms vs. 27.3 ± 22.4 ms in V₆; p = NS).

CONCLUSIONS: In accordance with the electrophysiological background, the typical ECG pattern of Brugada syndrome is also characterized by a considerable prolongation of the QT interval in right precordial leads.

Abbreviations and Acronyms   AP = action potential   ICC = intraclass correlation coefficient   PCR = polymerase chain reaction   QTc = QT interval corrected for heart rate   ROC = receiver operator characteristics   SSCP = single-strand conformation polymorphism

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