The r’-Wave Algorithm: A New Diagnostic Tool to Predict the Diagnosis of Brugada Syndrome after a Sodium Channel Blocker Provocation Test
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Electrocardiographic Analysis
2.3. Statistical Analysis
3. Results
3.1. Overall Population
3.2. Test Cohort
3.3. Validation Cohort
3.4. Intra- and Inter-Observer Variability
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
References
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Overall (n = 395) | Negative SCBPT (n = 300) | Positive SCBPT (n = 95) | p Value | |
---|---|---|---|---|
Age, years | 44.7 ± 13.5 | 44.1 ± 13.6 | 46.8 ± 12.9 | 0.090 |
Sex male, % (n) | 72.4 (286) | 73.3 (220) | 69.5 (29) | 0.463 |
LVEF, % | 58.7 ± 4.7 | 58.3 ± 5.3 | 59.3 ± 4.3 | 0.436 |
Flecainide administered, mg | 122 ± 13 | 130 ± 15 | 100 ± 12 | <0.0001 |
Indication for test | ||||
Suspicious ECG, % (n) | 24.2 (96) | 21.7 (65) | 32.6 (31) | 0.03 |
Symptoms, % (n) | 7.1 (28) | 6.7 (20) | 8.4 (8) | 0.561 |
Family history of BrS, % (n) | 49.5 (196) | 48.3 (145) | 52.6 (50) | 0.465 |
Family history of sudden cardiac death, % (n) | 19.2 (76) | 23.3 (70) | 6.3 (6) | <0.0001 |
Overall (n = 198) | Negative SCBPT (n = 150) | Positive SCBPT (n = 48) | p Value | |
---|---|---|---|---|
Age, years | 44.5 ± 13.3 | 44.1 ± 13.6 | 45.8 ± 12.2 | 0.455 |
Sex Male, % (n) | 70.2 (139) | 73.3 (110) | 60.4 (29) | 0.089 |
LVEF, % | 58.9 ± 4.3 | 58.2 ± 5.2 | 59.6 ± 4.1 | 0.463 |
Flecainide administered, mg | 123 ± 12 | 129 ± 14 | 101 ± 11 | <0.0001 |
Indication for test | ||||
Suspicious ECG, % (n) | 24.2 (48) | 23.3 (35) | 27.1 (13) | 0.598 |
Symptoms, % (n) | 6.1 (12) | 6.7 (10) | 4.2 (2) | 0.528 |
Family history of BrS, % (n) | 59.1 (117) | 60 (90) | 56.3 (27) | 0.646 |
Family history of sudden cardiac death, % (n) | 10.6 (21) | 10 (15) | 12.5 (6) | 0.624 |
Overall (n = 198) | Negative SCBPT (n = 150) | Positive SCBPT (n = 48) | p Value | |
---|---|---|---|---|
Heart rate, bpm | 73.2 ± 14.2 | 73.7 ± 15.1 | 71.6 ± 11.2 | 0.368 |
p-wave, ms | 104 ± 12.4 | 103.4 ± 12.4 | 106.2 ± 12.4 | 0.178 |
PR interval, ms | 159.1 ± 23.6 | 157.9 ± 23.5 | 162.8 ± 23.9 | 0.209 |
QRS duration, ms | 97.4 ± 7.4 | 97.2 ± 6.2 | 98.2 ± 10.4 | 0.410 |
QT interval, ms | 386.5 ± 25.2 | 385.6 ± 25.9 | 389.5 ± 23.2 | 0.358 |
QTc interval, ms | 418.8 ± 31.2 | 417.6 ± 33.2 | 422 ± 23.9 | 0.328 |
P axis, ° | 56.3 ± 21.4 | 57.2 ± 21.7 | 53.4 ± 20.4 | 0.291 |
QRS axis, ° | 41.4 ± 32.6 | 43.3 ± 34.3 | 36 ± 26.8 | 0.184 |
T axis, ° | 46.6 ± 21.5 | 45.80 ± 28.9 | 49.06 ± 23.2 | 0.360 |
Measurability of r’-wave at: | ||||
IV° ic, % (n) | 7.6 (15) | 4 (6) | 18.8 (9) | 0.001 |
III° ic, % (n) | 20.2 (40) | 16.7 (25) | 31.3 (15) | 0.029 |
II° ic, % (n) | 33.3 (66) | 22.7 (34) | 66.7 (32) | <0.0001 |
Majorβ-angle | 43.3 ± 16.7 | 34.3 ± 14.9 | 53.1 ± 12.6 | <0.0001 |
Majorα-angle | 32.9 ± 14.9 | 25.3 ± 12.5 | 41.4 ± 12.7 | <0.0001 |
Major DBT- 5 mm | 196.1 ± 126.2 | 149 ± 144.1 | 247.5 ± 76.9 | <0.0001 |
Major DBT- iso | 90.5 ± 34.5 | 74.6 ± 24.4 | 107.9 ± 35.8 | <0.0001 |
Major triangle base/height | 1.3 ± 0.7 | 1.1 ± 0.6 | 1.4 ± 0.7 | 0.03 |
Overall (n = 197) | Negative SCBPT (n = 150) | Positive SCBPT (n = 47) | p Value | |
---|---|---|---|---|
Age, years | 44.9 ± 13.7 | 44.1 ± 13.6 | 47.9 ± 13.7 | 0.101 |
Sex Male, % (n) | 74.6 (147) | 73.3 (110) | 78.7 (37) | 0.459 |
LVEF, % | 58.5 ± 4.6 | 58.2 ± 5.2 | 59.6 ± 4.1 | 0.463 |
Flecainide administered, mg | 122 ± 11 | 128 ± 15 | 102 ± 12 | <0.0001 |
Indication for test | ||||
Suspicious ECG, % (n) | 24.4 (48) | 20 (30) | 38.3 (18) | 0.01 |
Symptoms, % (n) | 8.1 (16) | 6.7 (10) | 12.8 (6) | 0.182 |
Family history of BrS, % (n) | 39.6 (78) | 36.7 (55) | 48.9 (23) | 0.133 |
Family history of sudden cardiac death, % (n) | 27.9 (55) | 36.7 (55) | 0 (0) | <0.0001 |
Overall (n = 197) | Negative SCBPT (n = 150) | Positive SCBPT (n = 47) | p Value | |
---|---|---|---|---|
Heart rate, bpm | 73.9 ± 15.1 | 73.7 ± 15.1 | 70.1 ± 14.8 | 0.150 |
p-wave, ms | 103.8 ± 12.7 | 103.4 ± 12.4 | 105.2 ± 13.8 | 0.392 |
PR interval, ms | 158.6 ± 24.7 | 157.9 ± 23.5 | 161 ± 28.3 | 0.451 |
QRS duration, ms | 97.8 ± 9.1 | 97.2 ± 6.2 | 99.7 ± 15.1 | 0.104 |
QT interval, ms | 385.8 ± 28.3 | 385.6 ± 25.9 | 386.3 ± 35.1 | 0.890 |
QTc interval, ms | 416.2 ± 30.8 | 417.6 ± 33.2 | 411.9 ± 21.1 | 0.280 |
P axis, ° | 55.5 ± 20.1 | 57.2 ± 21.7 | 50.1 ± 12.1 | 0.06 |
QRS axis, ° | 40.1 ± 34.5 | 43.3 ± 34.3 | 30.6 ± 33.7 | 0.06 |
T axis, ° | 44.3 ± 20.8 | 45.8 ± 28.9 | 39.7 ± 20.1 | 0.079 |
Measurability of r’-wave at: | ||||
IV° ic, % (n) | 11.2 (22) | 6 (9) | 27.7 (13) | <0.0001 |
III° ic, % (n) | 27.9 (55) | 18 (27) | 59.6 (28) | <0.0001 |
II° ic, % (n) | 34 (67) | 22.7 (34) | 70.2 (33) | <0.0001 |
Majorβ-angle | 41.4 ± 15.5 | 32.9 ± 8.7 | 50.4 ± 16.2 | <0.0001 |
Majorα-angle | 30.8 ± 12.4 | 24.6 ± 6.9 | 37.6 ± 13.5 | <0.0001 |
Major DBT- 5 mm | 151.3 ± 85.9 | 115.4 ± 54.5 | 189.2 ± 97.1 | <0.0001 |
Major DBT- iso | 89.9 ± 46.9 | 69.8 ± 20.5 | 112 ± 57.1 | <0.0001 |
Major triangle base/height | 1.2 ± 0.7 | 1.1 ± 0.6 | 1.3 ± 0.7 | 0.03 |
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Vetta, G.; Parlavecchio, A.; Pistelli, L.; Desalvo, P.; Lo Savio, A.; Magnocavallo, M.; Caminiti, R.; Tribuzio, A.; Vairo, A.; La Maestra, D.; et al. The r’-Wave Algorithm: A New Diagnostic Tool to Predict the Diagnosis of Brugada Syndrome after a Sodium Channel Blocker Provocation Test. Sensors 2023, 23, 3159. https://doi.org/10.3390/s23063159
Vetta G, Parlavecchio A, Pistelli L, Desalvo P, Lo Savio A, Magnocavallo M, Caminiti R, Tribuzio A, Vairo A, La Maestra D, et al. The r’-Wave Algorithm: A New Diagnostic Tool to Predict the Diagnosis of Brugada Syndrome after a Sodium Channel Blocker Provocation Test. Sensors. 2023; 23(6):3159. https://doi.org/10.3390/s23063159
Chicago/Turabian StyleVetta, Giampaolo, Antonio Parlavecchio, Lorenzo Pistelli, Paolo Desalvo, Armando Lo Savio, Michele Magnocavallo, Rodolfo Caminiti, Anna Tribuzio, Alessandro Vairo, Diego La Maestra, and et al. 2023. "The r’-Wave Algorithm: A New Diagnostic Tool to Predict the Diagnosis of Brugada Syndrome after a Sodium Channel Blocker Provocation Test" Sensors 23, no. 6: 3159. https://doi.org/10.3390/s23063159