Aims The authors sought to assess the value of the high right precordial leads (RPL) to detect the Type I Brugada ECG pattern in patients suspected of carrying Brugada syndrome (BrS).
Methods Ajmaline testing using 15-lead ECGs was performed in 183 patients suspected of carrying BrS. Standard 12-lead ECG with V1–V3 recorded from the fourth intercostal space and an additional three leads placed over V1–V3 recorded from the third intercostal space were analysed. ECGs were analysed for a Type I ECG pattern in either the standard or high RPLs.
Results Of the 183 tests, 31 (17%) were positive, and 152 were negative. In all positive studies, at least one high RPL became positive. In 13/31 (42%) cases, the Type I ECG pattern could be observed only in the high RPLs. Standard or high V3 were never positive before standard or high V1–V2. In seven patients, a Type I pattern was seen in one standard and one high RPL (vertical relationship).
Conclusions The high RPLs are more sensitive than the conventional 12-lead ECG alone and initial observations suggest that they remain specific for BrS, while standard and high lead V3 offer redundant data. A vertical relationship of type 1 patterns may have a similar diagnostic value to that of a horizontal pair.
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Funding MG is a BHF Fellow supported by a British Heart Foundation Grant (code PG/08/038/24217).
Competing interests None.
Ethics approval Ethics approval was provided by the Wandsworth REC.
Provenance and peer review Not commissioned; externally peer reviewed.
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