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The prognostic value of J-wave and ST-segment morphology after J-wave in inferolateral leads in Brugada syndrome without aborted sudden death and/or documented ventricular fibrillation

Background: Risk stratification in patients with Brugada Syndrome (BS) without aborted Sudden Death (SD) and/or documented Ventricular Fibrillation (VF) has not been clearly determined. The prognostic value of a J-wave and ST-segment morphology after the J-wave (ST) in inferolateral leads in Brugada Syndrome (BS) is still unknown.

Purpose To evaluate the prognostic value of a J-wave and ST in a large Japanese cohort of BS without aborted SD and/or documented VF.

Methods: A total of 376 consecutive BS patients without aborted SD and/or documented VF (mean age 53±14 years, 248 males) were enrolled. Clinical and ECG characteristics, including the presence and location of leads showing a J wave, ST-segment, and clinical outcomes, were evaluated in patients with syncope without documented VF (N = 109), and subjects without symptoms (N = 267).

Results: The incidence of J wave at inferior and/or lateral leads was 39 cases (10%). The prevalence of J wave between the 2 groups was not different. The incidence of cardiac events (SD or VF) during a mean follow-up period of 51±31 months was significantly higher in patients with symptoms, QRS duration in lead V2 > 90 ms, horizontal ST-segment after J wave, and the combination of a J wave in both inferior and lateral leads with horizontal ST-segment after the J wave, as determined by univariate analysis. J wave in both inferior and lateral leads tended to be associated with cardiac events. The combination of a J wave in both inferior and lateral leads with horizontal ST-segment after the J wave yielded a higher hazard ratio (5.08) than that of each parameter individually (2.71 and 3.24, respectively). Multivariate analysis revealed that symptoms, QRS duration in lead V2 > 90 ms, and the combination of a J wave in both inferior and lateral leads with horizontal ST-segment after J wave were significantly associated with cardiac events.

Conclusion: Presence of a J wave in multiple leads and horizontal ST-segments after the J wave may indicate a highly arrhythmogenic substrate in BS patients without aborted SD and/or documented VF.