Usefulness of ST elevation score by using vector-projected virtual 187-channel ECG for risk stratification in patients with Brugada-type ECG pattern

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Background: Although powerful defibrillation devices are available in clinical practice, risk stratification is important in asymptomatic Brugada syndrome. In this study, vector-projected 187-channel electrocardiogram (VP-ECG) was used to calculate the ST-elevation score in Brugada-type ECG and test its usefulness in risk stratification.Methods and results: VP-ECG was recorded in 108 patients with Brugada-type ECG having ventricular fibrillation (VF) episodes (±; n=13/95). The ST morphologies were evaluated in 80/187 precordial leads. The coved- and saddleback types (4–6 vs. 1–3 points) of ST-elevation scores in 332 recordings were 58±57 points, which were calculated using virtual ECG leads. Compared with types 1–3 ECG patterns, the scores were significantly different among the groups (107±65, 62±45, and 14±22, respectively; p<0.01). In patients with VF (–), that is, asymptomatic Brugada syndrome, new VF occurrences, family history, or inducible VF showed a higher score than in those without these occurrences (p<0.01).Conclusion: The ST elevation score in VP-ECG objectively documented the degree of ST elevation in surface ECG in Brugada-type ECG patterns. The ST-elevation score might be useful for risk stratification in patients with asymptomatic Brugada syndrome.