Controversial and similar aspects of the Brugada and J wave patterns: The vectorcardiogram point of view

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• 作者：Carlos Alberto Pastore ; MD ; PhD ; FESC ; ^{ecg_pastore@incor.usp.br" class="auth_mail" title="E-mail the corresponding author} ; Nelson Samesima ; MD ; PhD ; Horá ; cio G. Pereira Filho ; MD ; Bruna A. Madaloso ; MD
• 关键词：Diagnostic method ; Electrocardiography ; Vectorcardiography ; J-point ; Brugada syndrome ; Early repolarization ; J-wave patterns
• 刊名：Journal of Electrocardiology
• 出版年：2016
• 出版时间：May-June 2016
• 年：2016
• 卷：49
• 期：3
• 页码：439-445
• 全文大小：926 K

文摘

The J-wave electrocardiographic patterns include early repolarization (ER) and Brugada syndrome; especially when ER is located in the anteroseptal leads (V1–V3), it can mimic the Brugada syndrome (BrS) ECG pattern and therefore mislead the diagnosis. We aimed to define the vectorcardiographic characteristics of BrS and ER using aspects of QRS complex loop, J-point and ST-segment.

Methods/Results

Vectorcardiographic loops in the transverse plane (TP) of 14 BrS patients and 26 individuals with ER were analyzed and defined, and then a third group of 17 patients with non-characteristic ECG patterns were analyzed and compared with them. All QRS loops showed end-conduction delay (ECD) located in the right posterior-to-anterior quadrant (BrS) or left posterior-to-anterior quadrant (ER). In 100% cases a “break” in the QRS loop end, resembling a “nose” identified BrS, and a “fish-hook” shape identified ER. Non-coincidental QRS complex onset-end defined J-point resulting vector. BrS showed a significantly longer end-conduction delay (100% right anterior quadrant), shorter J-point amplitude oriented to the right, and “nose-like” QRS end loop. Analysis of group 3 confirmed the accuracy of the qualitative aspects to distinguish this “atypical” population: “fish-hook” shape of ER in the transverse plane in 6 individuals (one with both patterns seen in the sagittal plane); and the “nose” shape of BrS in 14 patients (two of which were diagnosed with both patterns in the transverse plane).

Conclusions

Vectorcardiographic characteristics could clearly differentiate BrS from ER qualitatively and quantitatively even in atypical ECGs.