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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

View larger version (65K): [in a new window]   Figure 1 Right and left precordial leads at baseline and after flecainide administration. (A) Shows a patient with a negative test; after flecainide QT is slightly prolonged in both the right and left precordial leads. (B) Shows a patient with a positive test; note the marked prolongation of QT in the right precordial leads, which is greater than that observed in the left precordial leads.

View larger version (16K): [in a new window]   Figure 2 QRS and QTc changes from baseline recorded in the right and left precordial leads in the negative (white columns) and positive groups (grey columns). Data expressed as mean values ± SE. *p < 0.01 vs. negative group; p < 0.01 vs. QTcV5, QTcV6.

View larger version (20K): [in a new window]   Figure 3 (A) Receiver operator characteristic curves obtained from the post-flecainide QTc in each lead. The value of the QTc interval in V2 has the greatest accuracy in discriminating negative from positive electrocardiograms (ECG) (see text for details). (B) Distribution of QTc intervals in V2 after flecainide administration. A QTc interval in V2 of >464 ms in females and >442 ms in males identified a positive ECG with 100% sensitivity and specificity. Closed circles = females with a positive test; open circles = females with a negative test; closed triangles = males with a positive test; open triangles = males with a negative test.

View larger version (52K): [in a new window]   Figure 4 Right and left precordial leads recorded in a patient with a baseline typical electrocardiogram pattern. The end of T wave in V1 and V2 is illustrated by the arrows.