# Yield of regular practice of high precordial leads electrocardiogram among asymptomatic upper Egyptian population considering Brugada patterns, a cross-sectional study

## TL;DR

This study found that using high precordial leads in ECGs helps detect Brugada patterns in asymptomatic Egyptians, with some cases later showing arrhythmias.

## Contribution

The study introduces the routine use of high precordial leads in an asymptomatic Egyptian population to detect Brugada patterns and assess arrhythmic risks.

## Key findings

- High precordial ECGs detected Brugada patterns in 2.52% of participants, compared to 0.63% with standard ECGs.
- 7 out of 8 Brugada-positive cases developed arrhythmias during follow-up.
- All Brugada-positive cases were male with no family history of sudden cardiac death.

## Abstract

This cross-sectional study with limited prospective cohort follow-up aimed to determine the prevalence of Brugada-type ECG patterns (BTEPs) among asymptomatic Upper Egyptians using standard and high precordial leads, and to assess the short-term arrhythmic outcomes of positive cases.

A total of 318 participants without arrhythmic symptoms were enrolled between June 2022 and June 2023. Standard 12-lead and high precordial ECGs (V1–V2 at 2nd intercostal space) were recorded. BTEPs were identified based on β-angle ≥ 58°, base length ≥ 1.5 mm at isoelectric line, and base width ≥ 4 mm at 0.5 mV. Positive cases underwent clinical follow up, echocardiography and Holter monitoring every 6 months for 12 months. Data was analyzed using McNemar’s test for paired proportions and logistic regression for confounder adjustment.

Two cases (0.63%; 95%CI: 0.17–2.26%) exhibited BTEPs on standard ECGs versus eight (2.52%; 95% CI:1.28–4.88%) on high precordial ECGs (p = 0.041). All positive cases were males. During follow-up, arrhythmias were documented in 7/8 cases (87.5%), including supraventricular tachycardia (n = 4), non-sustained VT (n = 1), and Mobitz I AV block (n = 1). No patient had family history of sudden cardiac death. The observed prevalence and arrhythmic rates were consistent with prior international data.

Routine use of High precordial leads ECG in upper Egyptians showed comparable benefit of detecting Brugada patterns as reported globally. In addition to type I, the follow up of originally asymptomatic type II and III Brugada patterns may show variable arrhythmic presentations. However, due to small sample size and short-term follow-up, results should be considered preliminary pending larger confirmatory studies.

Trial Registration Our study has been registered as a clinical trial, clinicalTrial.gov ID: NCT05116488 at 10th November 2021.