AUTHOR=Iqbal Mohammad , Putra Iwan Cahyo Santosa , Pranata Raymond , Budiarso Michael Nathaniel , Pramudyo Miftah , Goenawan Hanna , Akbar Mohammad Rizki , Kartasasmita Arief Sjamsulaksan 

TITLE=Electrocardiographic Markers Indicating Right Ventricular Outflow Tract Conduction Delay as a Predictor of Major Arrhythmic Events in Patients With Brugada Syndrome: A Systematic Review and Meta-Analysis

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.931622

DOI=10.3389/fcvm.2022.931622

ISSN=2297-055X

ABSTRACT=<sec><title>Introduction</title><p>Risk stratification in Brugada Syndrome (BrS) patients is still challenging due to the heterogeneity of clinical presentation; thus, some additional risk markers are needed. Several studies investigating the association between RVOT conduction delay sign on electrocardiography (ECG) and major arrhythmic events (MAE) in BrS patients showed inconclusive results. This meta-analysis aims to evaluate the association between RVOT conduction delay signs presented by aVR sign and large S wave in lead I, and MAE in BrS patients.</p></sec><sec><title>Methods</title><p>The literature search was performed using several online databases from the inception to March 16<sup>th</sup>, 2022. We included studies consisting of two main components, including ECG markers of RVOT conduction delay (aVR sign and large S wave in lead I) and MAE related to BrS (syncope/VT/VF/SCD/aborted SCD/appropriate ICD shocks)</p></sec><sec><title>Results</title><p>Meta-analysis of eleven cohort studies with a total of 2,575 participants showed RVOT conduction delay sign was significantly associated with MAE in BrS patients [RR = 1.87 (1.35, 2.58); <italic>p</italic> &lt; 0.001; <italic>I</italic><sup>2</sup>= 52%, <italic>P</italic><sub>heterogeneity</sub> = 0.02]. Subgroup analysis showed that aVR sign [RR = 2.00 (1.42, 2.83); <italic>p</italic> &lt; 0.001; <italic>I</italic><sup>2</sup>= 0%, <italic>P</italic><sub>heterogeneity</sub> = 0.40] and large S wave in lead I [RR = 1.74 (1.11, 2.71); <italic>p</italic> = 0.01; <italic>I</italic><sup>2</sup>= 60%, <italic>P</italic><sub>heterogeneity</sub> = 0.01] were significantly associated with MAE. Summary receiver operating characteristics analysis revealed the aVR sign [AUC: 0.77 (0.73–0.80)] and large S wave in lead I [AUC: 0.69 (0.65–0.73)] were a good predictor of MAE in BrS patients.</p></sec><sec><title>Conclusion</title><p>RVOT conduction delay sign, presented by aVR sign and large S wave in the lead I, is significantly associated with an increased risk of MAE in BrS patients. Hence, we propose that these parameters may be useful as an additional risk stratification tool to predict MAE in BrS patients.</p></sec><sec><title>Systematic Review Registration</title><p><ext-link ext-link-type="uri" xlink:href="https://www.crd.york.ac.uk/prospero/#recordDetails" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.crd.york.ac.uk/prospero/#recordDetails</ext-link>, identifier: CRD42022321090.</p></sec>