Abstract 13641: High Precordial Leads Increase the Detection of Brugada-Like Electrocardiographic Changes in Arrhythmogenic Right Ventricular Cardiomyopathy Patients and Healthy Controls
Bibliographic record
Abstract
Introduction: Diagnosis of Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) relies on the 2010 Task Force Criteria (TFC), known to have high specificity and low sensitivity. Diagnosis is complicated by variable phenotypic expression, potentially fatal first presentation of disease, and modest yield of genetic testing. Phenotypic overlap has been described between ARVC and Brugada Syndrome (BrS), while high precordial lead positioning increases the sensitivity for BrS diagnosis. Purpose: To explore the scope and nature of ECG changes in high precordial leads in ARVC. Methods: Patients seen in the Inherited Arrhythmia Clinic in Vancouver, Canada between 2013-2020 had high precordial lead ECGs recorded and were enrolled in the Canadian ARVC/HiRO Registry (www.heartsinrhythm.ca). ECGs of cases and matched healthy controls were interpreted blinded to phenotype/genotype. We defined 10 ECG variables, including features of the TFC and novel markers. We compared standard vs. high leads within-patient, and cases vs. controls in standard and high lead positions. Results: There were 58 ARVC patients (age 41±14, 48% male, TFC 3.6±1.7) and 58 controls (age 47±15, 43% male) included. Brugada-like ECG changes were seen in 5 patients (4.3%), exclusively in high leads (p<0.001 compared to standard leads). No type 1 pattern was detected. Type 2 pattern was seen in 1 ARVC patient (0.9%) in high lead V2. Type 3 pattern was seen in 2 ARVC patients (1.7%) and 2 controls (1.7%) in the high leads position, with no difference between cases and controls (p=NS). Epsilon waves were observed in 2 ARVC patients (1.7%). The SAECG was positive for late potentials in one patient, and the other negative. Both patients had an epsilon wave in a standard lead, and in one patient epsilon waves were seen in a further 2 high leads. No sex-differences were evident. Conclusions: High precordial leads increase detection of Brugada-like ECG changes to a similar extent in ARVC patients and controls. Our study supports the finding that Type 3 pattern is a benign finding in healthy individuals. High precordial leads do not substantially increase the sensitivity for detection of epsilon waves. Further investigation is warranted into novel diagnostic methods that improve sensitivity for ARVC diagnosis.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".