Transient ascending ST-segment depression and widening of the S wave in 3-channel Holter monitoring—A sign of dromotropic disturbance in the right ventricular outflow tract in the Brugada syndrome: A report of five cases

Antonio Thomaz de Andrade, Raimundo Barbosa-Barros, Kjell Nikus, Rodrigo D. Raimundo, Luiz C. de Abreu, Luciana Sacilotto, Francisco C.C. Darriuex, Frank G. Yanowitz, Pedro Brugada, Andrés Ricardo Pérez-Riera

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Abstract

Background: Brugada syndrome (BrS) is somewhat a challenging diagnosis, due to its dynamic pattern. One of the aspects of this disease is a significant conduction disorder located in the right ventricular outflow tract (RVOT), which can be explained as a consequence of low expression of Connexin-43. This decreased conduction speed is responsible for the typical electrocardiographic pattern. Opposite leads located preferably in inferior leads of the electrocardiogram may show a deep and widened S wave associated with ascending ST segment depression. Holter monitoring electrocardiographic (ECG) aspects is still a new frontier of knowledge in BrS, especially in intermittent clinical presentations. Methods: We describe, as an exploratory analysis, five case series of intermittent type 1 BrS to demonstrate the appearance of ascending ST segment depression and widening of the S wave, during 3-channel 24h-Holter monitoring (C1, C2 and C3) with bipolar leads. Results: In the five cases described, the ST segment depression was observed mainly in C2, but in some cases also in C1 and C3. Only case 1 presented concomitant intermittent elevation of the ST segment in C1. All cases were intermittent. Conclusion: The recognition of an ECG pattern with ascending ST-segment depression and widening of the S wave in 3-channel Holter described in this case series should raise a suspicion of the BrS and suggests the counterpart of a dromotropic disturbance registered in the RVOT and/or reciprocal changes.

Original languageEnglish
Article numbere12917
JournalANNALS OF NONINVASIVE ELECTROCARDIOLOGY
Volume27
Issue number2
Early online date2021
DOIs
Publication statusPublished - 2022
Publication typeA1 Journal article-refereed

Keywords

  • Brugada syndrome
  • Dromotropic disturbance in the right ventricular outflow tract
  • Holter monitoring
  • S wave
  • ST-segment depression

Publication forum classification

  • Publication forum level 1

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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