Diagnostics (Basel). 2026 Jun 3;16(11):1718. doi: 10.3390/diagnostics16111718.
ABSTRACT
Background/Objectives: The Type 1 Brugada ECG pattern (BrP1) fluctuates according to autonomic influences. Tilt table testing induces changes in both sympathetic and parasympathetic activity. It may provide insights into the dynamic behavior of BrP1 when combined with high-precordial lead placement. However, the clinical significance of BrP1 variability during tilt table testing remains poorly defined. Methods: This cross-sectional study evaluated patients with confirmed Brugada syndrome who underwent tilt table testing with continuous ECG monitoring using high-precordial leads. BrP1 behavior was assessed during predefined phases: baseline supine position, orthostatic tilt, nitrate administration, recovery, and syncope when present. Subsequently, clinical characteristics and test results were analyzed for associations with dynamic BrP1 expression. Results: Forty-four patients (mean age 49 years; 72.7% men) were included. Thirty-five patients (79.5%) had a spontaneous type 1 Brugada ECG pattern, and nine (20.5%) had a drug-induced pattern. BrP1 expression varied dynamically/heterogeneously during tilt table testing. No patient without BrP1 at admission developed the pattern during tilt phases. Thirty patients (68.1%) remained negative throughout testing, while five lost the pattern during the test (11.3%), and nine (20.4%) showed persistent BrP1 in all phases. Persistent BrP1 was associated with more frequent presumed arrhythmic syncope and implantable cardioverter defibrillator implantation (p < 0.05). No atrial or ventricular arrhythmias or device-related complications occurred. Conclusions: Tilt table testing with high precordial leads does not unmask BrP1 and should not be used as a diagnostic provocation tool. However, it allows for the characterization of autonomic modulation and phenotypic stability in Brugada syndrome. Any potential prognostic relevance of dynamic BrP1 behavior remains speculative and requires evaluation in adequately powered prospective studies.
PMID:42279585 | PMC:PMC13256500 | DOI:10.3390/diagnostics16111718