{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:06:17Z","timestamp":1790136377416,"version":"4.0.1"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2023,7,6]],"date-time":"2023-07-06T00:00:00Z","timestamp":1688601600000},"content-version":"vor","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","award":["#2016\/15223-3"],"award-info":[{"award-number":["#2016\/15223-3"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>High 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>74 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 \u2018quick lay down\u2019). For heart rate recovery (HRR) measurements and comparisons, a Student\u2019s t-test was applied. McNemar tests compared the detection of Br1ECGp. The significance level was defined as P &amp;lt; 0.05. Fifty-seven patients (57\/74; 77%) were male, the mean age was 49.0 \u00b1 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Stress 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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/europace\/euad157","type":"journal-article","created":{"date-parts":[[2023,7,6]],"date-time":"2023-07-06T16:31:54Z","timestamp":1688661114000},"source":"Crossref","is-referenced-by-count":19,"title":["Evaluation of a new treadmill exercise protocol to unmask type 1 Brugada electrocardiographic pattern: can we improve diagnostic yield?"],"prefix":"10.1093","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7175-3593","authenticated-orcid":false,"given":"Nemer L","family":"Pichara","sequence":"first","affiliation":[{"name":"Departament of Ergometry\u2014Instituto do Coracao (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , Brazil - 05403-900"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3679-5349","authenticated-orcid":false,"given":"Luciana","family":"Sacilotto","sequence":"additional","affiliation":[{"name":"Arrhythmia Unit\u2014Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Av. Dr. Eneas de Carvalho Aguiar, 44 AB, CEP 05403-900 Sao Paulo , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7327-2275","authenticated-orcid":false,"given":"Maur\u00edcio I","family":"Scanavacca","sequence":"additional","affiliation":[{"name":"Arrhythmia Unit\u2014Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Av. Dr. Eneas de Carvalho Aguiar, 44 AB, CEP 05403-900 Sao Paulo , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4613-4181","authenticated-orcid":false,"given":"Ac\u00e1cio Fernandes","family":"Cardoso","sequence":"additional","affiliation":[{"name":"Electrocardiology Service, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , Brazil - 05403-900"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5203-3312","authenticated-orcid":false,"given":"Beatriz Moreira Ayub Ferreira","family":"Soares","sequence":"additional","affiliation":[{"name":"Departament of Ergometry\u2014Instituto do Coracao (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , Brazil - 05403-900"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4835-9285","authenticated-orcid":false,"given":"Paola P PN F","family":"Falcochio","sequence":"additional","affiliation":[{"name":"Departament of Ergometry\u2014Instituto do Coracao (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , Brazil - 05403-900"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2333-2828","authenticated-orcid":false,"given":"Andrea M G","family":"Falc\u00e3o","sequence":"additional","affiliation":[{"name":"Departament of Ergometry\u2014Instituto do Coracao (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , Brazil - 05403-900"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1061-8982","authenticated-orcid":false,"given":"Natalia","family":"Olivetti","sequence":"additional","affiliation":[{"name":"Laboratory of Genetics and Molecular Cardiology (LGMC) Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , Brazil - 05403-900"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5818-5958","authenticated-orcid":false,"given":"Francisco Carlos","family":"da Costa Darrieux","sequence":"additional","affiliation":[{"name":"Arrhythmia Unit\u2014Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Av. Dr. Eneas de Carvalho Aguiar, 44 AB, CEP 05403-900 Sao Paulo , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3751-0728","authenticated-orcid":false,"given":"William A","family":"Chalela","sequence":"additional","affiliation":[{"name":"Departament of Ergometry\u2014Instituto do Coracao (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo , Sao Paulo , Brazil - 05403-900"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,7,6]]},"reference":[{"key":"2023070616304351300_euad157-B1","doi-asserted-by":"crossref","first-page":"3997","DOI":"10.1093\/eurheartj\/ehac262","article-title":"2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death","volume":"43","author":"Zeppenfeld","year":"2022","journal-title":"Eur Heart 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