New methodologies for measuring Brugada ECG patterns cannot differentiate the ECG pattern of Brugada syndrome from Brugada phenocopy

• Previous studies show specific ECG criteria are sensitive and specific for diagnosis of a type-2 Brugada ECG pattern.
• We used these criteria to distinguish between the ECGs of Brugada phenocopy and Brugada syndrome.
• These criteria were unable to distinguish between the ECG patterns of the two conditions.
• This information provides another level of evidence that the two patterns are indistinguishable.

BackgroundBrugada phenocopies (BrP) are clinical entities characterized by ECG patterns that are identical to true Brugada syndrome (BrS), but are elicited by various clinical circumstances. A recent study demonstrated that the patterns of BrP and BrS are indistinguishable under the naked eye, thereby validating the concept that the patterns are identical.ObjectiveThe aim of our study was to determine whether recently developed ECG criteria would allow for discrimination between type-2 BrS ECG pattern and type-2 BrP ECG pattern.MethodsTen ECGs from confirmed BrS (aborted sudden death, transformation into type 1 upon sodium channel blocking test and/or ventricular arrhythmias, positive genetics) cases and 9 ECGs from confirmed BrP were included in the study. Surface 12-lead ECGs were scanned, saved in JPEG format for blind measurement of two values: (i) β-angle; and (ii) the base of the triangle. Cut-off values of ≥ 58° for the β-angle and ≥ 4 mm for the base of the triangle were used to determine the BrS ECG pattern.ResultsMean values for the β-angle in leads V1 and V2 were 66.7 ± 25.5 and 55.4 ± 28.1 for BrS and 54.1 ± 26.5 and 43.1 ± 16.1 for BrP respectively (p = NS). Mean values for the base of the triangle in V1 and V2 were 7.5 ± 3.9 and 5.7 ± 3.9 for BrS and 5.6 ± 3.2 and 4.7 ± 2.7 for BrP respectively (p = NS). The β-angle had a sensitivity of 60%, specificity of 78% (LR + 2.7, LR − 0.5). The base of the triangle had a sensitivity of 80%, specificity of 40% (LR + 1.4, LR − 0.5).ConclusionsNew ECG criteria presented relatively low sensitivity and specificity, positive and negative predictive values to discriminate between BrS and BrP ECG patterns, providing further evidence that the two patterns are identical.