Criteria for evaluating rSr′ patterns due to high precordial ECG lead placement accurately confirm absence of a Brugada ECG pattern

Background: An rSr' pattern in leads V-1-V-2 can be observed when ECG leads are placed in the 2nd intercostal space. Recently, three criteria analyzing the ST segment and r' width to identify true Brugada pattern ECGs have been described. Objectives: To assess the feasibility and reliability of using high precordial lead ECGs in conjunction with three new criteria for identifying true Brugada pattern ECGs. Methods: ECGs of 491 college athletes and 181 non-athletes were performed with standard and high-lead ECGs. ECGs were then analyzed using the newly proposed criteria. Results: Zero patients had a Brugada type 1 or 2 pattern at baseline; 76 patients demonstrated an rSr' pattern in leads V-1-V-2 on the high-lead ECG. Two of the 76 (3%) met criteria suggesting a true Brugada ECG. Conclusion: New ECG criteria based on the r' wave accurately identify rSr' patterns in V-1-V-2 from potential Brugada type 2 patterns in patients with purposely placed high precordial leads. (C) 2016 Elsevier Inc. All rights reserved.