The r’-Wave Algorithm: A New Diagnostic Tool to Predict the Diagnosis of Brugada Syndrome after a Sodium Channel Blocker Provocation Test Article Swipe
Giampaolo Vetta
,
Antonio Parlavecchio
,
Lorenzo Pistelli
,
Paolo Desalvo
,
Armando Lo Savio
,
Michele Magnocavallo
,
Rodolfo Caminiti
,
Anna Tribuzio
,
Alessandro Vairo
,
Diego La Maestra
,
Francesco Vetta
,
Giuseppe Dattilo
,
Francesco Luzza
,
Gianluca Di Bella
,
Roberta Rossini
,
Domenico G. Della Rocca
,
Pasquale Crea
·
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.3390/s23063159
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.3390/s23063159
A diagnosis of Brugada syndrome (BrS) is based on the presence of a type 1 electrocardiogram (ECG) pattern, either spontaneously or after a Sodium Channel Blocker Provocation Test (SCBPT). Several ECG criteria have been evaluated as predictors of a positive SCBPT, such as the β-angle, the α-angle, the duration of the base of the triangle at 5 mm from the r’-wave (DBT- 5 mm), the duration of the base of the triangle at the isoelectric line (DBT- iso), and the triangle base/height ratio. The aim of our study was to test all previously proposed ECG criteria in a large cohort study and to evaluate an r’-wave algorithm for predicting a BrS diagnosis after an SCBPT. We enrolled all patients who consecutively underwent SCBPT using flecainide from January 2010 to December 2015 in the test cohort and from January 2016 to December 2021 in the validation cohort. We included the ECG criteria with the best diagnostic accuracy in relation to the test cohort in the development of the r’-wave algorithm (β-angle, α-angle, DBT- 5 mm, and DBT- iso.) Of the total of 395 patients enrolled, 72.4% were male and the average age was 44.7 ± 13.5 years. Following the SCBPTs, 24.1% of patients (n = 95) were positive and 75.9% (n = 300) were negative. ROC analysis of the validation cohort showed that the AUC of the r’-wave algorithm (AUC: 0.92; CI 0.85–0.99) was significantly better than the AUC of the β-angle (AUC: 0.82; 95% CI 0.71–0.92), the α-angle (AUC: 0.77; 95% CI 0.66–0.90), the DBT- 5 mm (AUC: 0.75; 95% CI 0.64–0.87), the DBT- iso (AUC: 0.79; 95% CI 0.67–0.91), and the triangle base/height (AUC: 0.61; 95% CI 0.48–0.75) (p < 0.001), making it the best predictor of a BrS diagnosis after an SCBPT. The r’-wave algorithm with a cut-off value of ≥2 showed a sensitivity of 90% and a specificity of 83%. In our study, the r’-wave algorithm was proved to have the best diagnostic accuracy, compared with single electrocardiographic criteria, in predicting the diagnosis of BrS after provocative testing with flecainide.
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- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.3390/s23063159
- https://www.mdpi.com/1424-8220/23/6/3159/pdf?version=1679277560
- OA Status
- gold
- Cited By
- 2
- References
- 18
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4327618763
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- OpenAlex ID
-
https://openalex.org/W4327618763Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.3390/s23063159Digital Object Identifier
- Title
-
The r’-Wave Algorithm: A New Diagnostic Tool to Predict the Diagnosis of Brugada Syndrome after a Sodium Channel Blocker Provocation TestWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2023Year of publication
- Publication date
-
2023-03-16Full publication date if available
- Authors
-
Giampaolo Vetta, Antonio Parlavecchio, Lorenzo Pistelli, Paolo Desalvo, Armando Lo Savio, Michele Magnocavallo, Rodolfo Caminiti, Anna Tribuzio, Alessandro Vairo, Diego La Maestra, Francesco Vetta, Giuseppe Dattilo, Francesco Luzza, Gianluca Di Bella, Roberta Rossini, Domenico G. Della Rocca, Pasquale CreaList of authors in order
- Landing page
-
https://doi.org/10.3390/s23063159Publisher landing page
- PDF URL
-
https://www.mdpi.com/1424-8220/23/6/3159/pdf?version=1679277560Direct link to full text PDF
- Open access
-
YesWhether a free full text is available
- OA status
-
goldOpen access status per OpenAlex
- OA URL
-
https://www.mdpi.com/1424-8220/23/6/3159/pdf?version=1679277560Direct OA link when available
- Concepts
-
Cohort, Brugada syndrome, Algorithm, Provocation test, Medicine, Internal medicine, Sodium channel blocker, Receiver operating characteristic, Flecainide, Area under the curve, Sodium channel, Mathematics, Pathology, Sodium, Atrial fibrillation, Chemistry, Organic chemistry, Alternative medicineTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
2Total citation count in OpenAlex
- Citations by year (recent)
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2025: 1, 2024: 1Per-year citation counts (last 5 years)
- References (count)
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18Number of works referenced by this work
- Related works (count)
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10Other works algorithmically related by OpenAlex
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