Prognostic Value of Small Coved‐Type ST‐Segment Area in Patients With Spontaneous Type 1 Brugada Syndrome

BACKGROUND: Risk stratification in Brugada syndrome (BrS) remains challenging. Although spontaneous Type 1 ECG and clinical history (e.g., prior ventricular fibrillation [VF] or syncope) are established risk markers, additional electrocardiographic predictors are needed to refine prognostication. METHODS: We retrospectively analyzed 82 consecutive BrS patients referred to Oita University Hospital. After excluding 20 patients with drug-induced and 2 with fever-induced Type 1 ECG, 60 patients with spontaneous Type 1 Brugada ECG were included. The maximum coved-type ST-segment area (mV·ms) was quantified across leads V1-V3 at standard and high-intercostal positions. Patients were categorized into VF-occurrence (n = 24) and non-occurrence (n = 36) groups. RESULTS: Over a mean follow-up of 67 ± 59 months, 24 patients (40%) experienced VF. The maximum coved-type ST-segment area was significantly smaller in the VF-occurrence group compared with the non-occurrence group (27.7 ± 14.8 vs. 37.5 ± 16.7 mV·ms; p = 0.022). In multivariate analysis, inferolateral J waves (OR 11.1; 95% CI 2.85-42.8; p < 0.001) and a small maximum coved-type ST-segment area (OR 5.47; 95% CI 1.17-25.7; p = 0.03) were independent predictors of VF. Kaplan-Meier analysis showed significantly lower VF-free survival in patients with a small maximum coved-type ST-segment area (p = 0.034). CONCLUSIONS: In patients with spontaneous Type 1 BrS, a small coved-type ST-segment area may be independently associated with VF and may represent a potential electrocardiographic marker for risk stratification.