The Clinical Characteristics of Cases Exhibiting Suggestive Brugada ECG (Type-S) at Higher Intercostal Spaces

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Background: Recent findings report that in Brugada syndrome, the long-term prognosis of patients with non-type-1 ECG, including mild coved ST-elevation (STE)<2 mm, was similar to that of patients displaying type-1 ECG. Based on these evidences, the computerized diagnosis of Brugada-type ECG have been reported to be classified into 3 types: Type-1 (coved STE≥2 mm), Type-2/3 (saddleback STE≥2 mm), and suggestive Brugada ECG: Type-S (coved STE between 1–2 mm). Type-1 ECG can be occasionally unmasked only when recorded at higher intercostal spaces (HICS). This study focused on Type-S recorded at HICS. Method: Screening ECG from 12850 consecutive patients (6616 males) undergoing health checkups was reviewed. Among the total patients, 156 patients (1.2%) (134 males) identified as having RSR'-pattern ECG in leads V1 and/or V2 without Brugada-type ECG at 4th intercostal space, were enrolled. We analyzed ECGs recorded at 3rd and 2nd intercostal spaces (HICS). Results: In 8 of 156 cases (5%), RSR'-pattern shifted to Type-S ECG at HICS. All 8 cases were asymptomatic and male. Their age ranged between 42 and 68. Conclusion: Our results indicated that men with RSR'-pattern ECG who are in their middle years may have a potentially Brugada-type ECG.