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. 2023 Oct;9(10):2096-2105.
doi: 10.1016/j.jacep.2023.06.011. Epub 2023 Aug 9.

Atrial Abnormalities in Brugada Syndrome: Evaluation With ECG Imaging

Antonio Bisignani  1 , Luigi Pannone  2 , Alvise Del Monte  3 , Ivan Eltsov  3 , Ida Anna Cappello  3 , Juan Sieira  3 , Cinzia Monaco  3 , Gezim Bala  3 , Sahar Mouram  3 , Domenico Giovanni Della Rocca  3 , Erwin Ströker  3 , Ingrid Overeinder  3 , Alexandre Almorad  3 , Gudrun Pappaert  3 , Anaïs Gauthey  3 , Thomy de Ravel  4 , Sonia Van Dooren  5 , Antonio Sorgente  3 , Mark La Meir  6 , Andrea Sarkozy  3 , Pedro Brugada  3 , Gian-Battista Chierchia  3 , Carlo de Asmundis  7
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Free article

Atrial Abnormalities in Brugada Syndrome: Evaluation With ECG Imaging

Antonio Bisignani et al. JACC Clin Electrophysiol. 2023 Oct.
Free article

Abstract

Background: Patients with Brugada syndrome (BrS) have an increased risk of arrhythmias, including atrial tachyarrhythmias (ATas).

Objectives: The purpose of this study was to assess underlying atrial cardiomyopathy in BrS and the effect of ajmaline (AJM) test on the atrium of BrS patients using electrocardiogram imaging (ECGI).

Methods: All consecutive patients diagnosed with BrS in a monocentric registry were screened and included if they met the following criteria: 1) BrS diagnosed following current recommendations; and 2) ECGI map performed before and after AJM with a standard protocol. Consecutive patients with no structural heart disease or BrS who had undergone ECGI were included as a control group. Genetic analysis for SCN5A was performed in all BrS patients. Total atrial conduction time (TACT) and local atrial conduction time (LACT) were calculated from atrial ECGI. The primary endpoint was ATas during follow-up.

Results: Forty-three consecutive BrS patients and 40 control patients were included. Both TACT and LACT were significantly prolonged in BrS patients compared with control patients. Furthermore, TACT and LACT were significantly higher after AJM administration and in BrS patients who were carriers of a pathogenic/likely pathogenic SCN5A variant. After a mean follow-up of 40.9 months, 6 patients experienced a first ATa occurrence (all in the BrS group, 13.9%). TACT was the only independent predictor of ATas with a cutoff of >138.5 ms (sensitivity 0.92 [95% CI: 0.83-0.98], specificity 0.70 [95% CI: 0.59-0.81]).

Conclusions: ECGI-calculated TACT and LACT are significantly prolonged in BrS patients compared with control patients, and in BrS patients after AJM. This may be consistent with a concealed atrial cardiomyopathy in BrS.

Keywords: Brugada syndrome; ECG imaging; atrial fibrillation.

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Conflict of interest statement

Funding Support and Author Disclosures Dr La Meir is a consultant for Atricure. Dr Brugada has received compensation for teaching purposes from Biotronik. Dr Chierchia has received compensation for teaching purposes and proctoring from Medtronic, Abbott, Biotronik, Boston Scientific, and Acutus Medical. Dr de Asmundis receives research grants on behalf of the center from Biotronik, Medtronic, Abbott, LivaNova, Boston Scientific, AtriCure, Philips, and Acutus; and has received compensation for teaching purposes and proctoring from Medtronic, Abbott, Biotronik, Livanova, Boston Scientific, Atricure, Acutus Medical, and Daiichi Sankyo. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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