Criteria for evaluating rSr′ patterns due to high precordial ECG lead placement accurately confirm absence of a Brugada ECG pattern

• Differentiating true Brugada pattern from rSr′ patterns in V1–V2 is difficult.
• rSr′ pattern can be seen when ECG leads are placed in the 2nd intercostal space.
• We used high lead ECGs and three new criteria to differentiate potential Brugada from rSr′.
• This technique can be used in clinic when there is concern for Brugada syndrome.

BackgroundAn rSr′ pattern in leads V1–V2 can be observed when ECG leads are placed in the 2nd intercostal space. Recently, three criteria analyzing the ST segment and r′ width to identify true Brugada pattern ECGs have been described.ObjectivesTo assess the feasibility and reliability of using high precordial lead ECGs in conjunction with three new criteria for identifying true Brugada pattern ECGs.MethodsECGs of 491 college athletes and 181 non-athletes were performed with standard and high-lead ECGs. ECGs were then analyzed using the newly proposed criteria.ResultsZero patients had a Brugada type 1 or 2 pattern at baseline; 76 patients demonstrated an rSr′ pattern in leads V1–V2 on the high-lead ECG. Two of the 76 (3%) met criteria suggesting a true Brugada ECG.ConclusionNew ECG criteria based on the r′ wave accurately identify rSr′ patterns in V1–V2 from potential Brugada type 2 patterns in patients with purposely placed high precordial leads.