Characterization of repolarization in Brugada syndrome patients during exercise testing: Dynamic angle evaluation

•Beta angle and base of the triangle are new geometrical criteria for Brugada pattern.•These criteria had never been studied during exercise.•We compared BrS patients and IRBBB patients during exercise.•The two criteria were significantly larger in BrS at rest, exercise and recovery.•There was a significant rebound in angle at recovery in controls contrary to BrS.

BackgroundA new ECG criterion has been studied in Brugada syndrome (BrS) at rest to differentiate type 2 and incomplete right bundle branch block (IRBBB).MethodsWe assessed this criterion during exercise comparing BrS (46 patients) and IRBBB (17 patients). A beta angle was measured from lead V1 between the upslope of S-wave and the downslope of the r'-wave.ResultsBeta angle was significantly larger in BrS at rest (58 ± 24° vs 25 ± 15°, p < 0.001), exercise (47 ± 26° vs 15 ± 11°, p < 0.001), and recovery (46 ± 24° vs 21 ± 12°, p < 0.001) with a reduction in angle at exercise compared to rest. There was a significant rebound in angle at recovery in the control group to (p < 0.001); no such rebound was observed in the BrS group (p = NS).ConclusionBeta angle study at rest and its evolution at exercise could help discriminate BrS patients from healthy subjects.

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