Prognostic Value of Small Coved-Type ST-Segment Area in Patients With Spontaneous Type 1 Brugada Syndrome.

BACKGROUND

Risk stratification in Brugada syndrome (BrS) remains challenging. Although spontaneous Type 1 ECG and clinical history (e.g., prior ventricular fibrillation [VF] or syncope) are established risk markers, additional electrocardiographic predictors are needed to refine prognostication.

METHODS

We retrospectively analyzed 82 consecutive BrS patients referred to Oita University Hospital. After excluding 20 patients with drug-induced and 2 with fever-induced Type 1 ECG, 60 patients with spontaneous Type 1 Brugada ECG were included. The maximum coved-type ST-segment area (mV·ms) was quantified across leads V1-V3 at standard and high-intercostal positions. Patients were categorized into VF-occurrence (n = 24) and non-occurrence (n = 36) groups.

RESULTS

Over a mean follow-up of 67 ± 59 months, 24 patients (40%) experienced VF. The maximum coved-type ST-segment area was significantly smaller in the VF-occurrence group compared with the non-occurrence group (27.7 ± 14.8 vs. 37.5 ± 16.7 mV·ms; p = 0.022). In multivariate analysis, inferolateral J waves (OR 11.1; 95% CI 2.85-42.8; p < 0.001) and a small maximum coved-type ST-segment area (OR 5.47; 95% CI 1.17-25.7; p = 0.03) were independent predictors of VF. Kaplan-Meier analysis showed significantly lower VF-free survival in patients with a small maximum coved-type ST-segment area (p = 0.034).

CONCLUSIONS

In patients with spontaneous Type 1 BrS, a small coved-type ST-segment area may be independently associated with VF and may represent a potential electrocardiographic marker for risk stratification.