ArticleEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2023
Evaluation of a new treadmill exercise protocol to unmask type 1 Brugada electrocardiographic pattern: can we improve diagnostic yield?
Article in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.
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13 citing papers in PubMed, 2 syntheses or guidelines pooled it, 13 citations in OpenAlex.
- Brazilian Guideline for Exercise Testing in Children and Adolescents - 2024.Arquivos brasileiros de cardiologia · 2024Guideline
- Brazilian Guideline for Exercise Test in the Adult Population - 2024.Arquivos brasileiros de cardiologia · 2024Guideline
- Sports Cardiology in Practice: Exercise as Stressor, Signal, and Therapy.Journal of cardiovascular development and disease · 2026Article
- Dynamic Expression of the Type 1 Brugada ECG Pattern During Tilt Table Testing Using Continuous High Precordial Lead Positioning.Diagnostics (Basel, Switzerland) · 2026Article
- Exercise and Exercise Stress Testing in Brugada Syndrome: Diagnostic, Prognostic, and Safety Implications.JACC. Asia · 2026Review
- Physical activity and competitive sport safety for children affected by inherited cardiac conditions and selected acquired cardiomyopathies: emerging evidence and areas for further inquiry.European journal of pediatrics · 2026Review
- Exercise stress test unmasking a Brugada pattern in a survivor of cardiac arrest: a case report.European heart journal. Case reports · 2026Article
- Case series of Type 1 Brugada pattern provoked by exercise: a role for diagnostic treadmill stress testing.European heart journal. Case reports · 2026Article
- Beyond the type 1 pattern: comprehensive risk stratification in Brugada syndrome.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2025Review
- Brugada Syndrome and Exercise: Is It Time for a Paradigm Change?Journal of cardiovascular development and disease · 2025Review
- Brugada pattern changes during tilt table test with high precordial leads. An exploratory data to better understand the dynamic profile.Clinics (Sao Paulo, Brazil) · 2025Observational
- The role for ambulatory electrocardiogram monitoring in the diagnosis and prognostication of Brugada syndrome: a sub-study of the Rare Arrhythmia Syndrome Evaluation (RASE) Brugada study.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024Article
- Sixty years of the Bruce protocol: reappraising the contemporary role of exercise stress testing with electrocardiographic monitoring.Porto biomedical journalReview
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10 authors at 1 institution in 1 country.
Funding
Abstract
aimsHigh precordial leads (HPL) on the resting electrocardiogram (ECG) are widely used to improve diagnostic detection of type 1 Brugada ECG pattern (Br1ECGp). A parasympathetic activation marks the initial recovery phase of treadmill stress testing (TET), and this can be useful for detecting the typical ECG pattern. Our study aimed to evaluate the role of a new HPL-treadmill exercise testing (TET) protocol in detecting Br1ECGp fluctuation compared to resting HPL-ECG. METHODS AND
results74 out of 163 patients of a Brugada syndrome (BrS) Brazilian cohort (GenBra Registry) underwent exercise testing with HPL-TET protocol. Precordial leads were displayed in strategic positions in the right and left parasternal spaces. The step-by-step analysis included ECG classification (as presence or absence of Br1ECGp) in standard vs. HPL leads placement in the following sequences: resting phase, maximal exercise, and the passive recovery phase (including 'quick lay down'). For heart rate recovery (HRR) measurements and comparisons, a Student's t-test was applied. McNemar tests compared the detection of Br1ECGp. The significance level was defined as P < 0.05. Fifty-seven patients (57/74; 77%) were male, the mean age was 49.0 ± 14, 78.4% had spontaneous BrS, and the mean Shanghai score was 4.5. The HPL-TET protocol increased Br1ECGp detection by 32.4% against resting HPL-ECG (52.7% vs. 20.3%, P = 0.001) alone.
conclusionStress testing using HPL with the passive recovery phase in the supine position offers an opportunity to unmask the type 1 Br1ECGp, which could increase the diagnostic yield in this population.
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