{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T17:20:55Z","timestamp":1790443255645,"version":"4.1.0"},"reference-count":55,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T00:00:00Z","timestamp":1738195200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Foreign Affairs and International Cooperation (MAECI)","award":["1873\/21"],"award-info":[{"award-number":["1873\/21"]}]},{"name":"Italian Ministry of Foreign Affairs and International Cooperation (MAECI)","award":["3-16414"],"award-info":[{"award-number":["3-16414"]}]},{"name":"Italian Ministry of Foreign Affairs and International Cooperation (MAECI)","award":["3-17927"],"award-info":[{"award-number":["3-17927"]}]},{"name":"Italian Ministry of Foreign Affairs and International Cooperation (MAECI)","award":["311514"],"award-info":[{"award-number":["311514"]}]},{"name":"Italian Ministry of Foreign Affairs and International Cooperation (MAECI)","award":["32-G-13427-2 (DM 1062\/2021)"],"award-info":[{"award-number":["32-G-13427-2 (DM 1062\/2021)"]}]},{"name":"Israel Science Foundation","award":["1873\/21"],"award-info":[{"award-number":["1873\/21"]}]},{"name":"Israel Science Foundation","award":["3-16414"],"award-info":[{"award-number":["3-16414"]}]},{"name":"Israel Science Foundation","award":["3-17927"],"award-info":[{"award-number":["3-17927"]}]},{"name":"Israel Science Foundation","award":["311514"],"award-info":[{"award-number":["311514"]}]},{"name":"Israel Science Foundation","award":["32-G-13427-2 (DM 1062\/2021)"],"award-info":[{"award-number":["32-G-13427-2 (DM 1062\/2021)"]}]},{"name":"Israel Ministry of Science Technology and Space","award":["1873\/21"],"award-info":[{"award-number":["1873\/21"]}]},{"name":"Israel Ministry of Science Technology and Space","award":["3-16414"],"award-info":[{"award-number":["3-16414"]}]},{"name":"Israel Ministry of Science Technology and Space","award":["3-17927"],"award-info":[{"award-number":["3-17927"]}]},{"name":"Israel Ministry of Science Technology and Space","award":["311514"],"award-info":[{"award-number":["311514"]}]},{"name":"Israel Ministry of Science Technology and Space","award":["32-G-13427-2 (DM 1062\/2021)"],"award-info":[{"award-number":["32-G-13427-2 (DM 1062\/2021)"]}]},{"name":"Italy &amp; Israel Corporation","award":["1873\/21"],"award-info":[{"award-number":["1873\/21"]}]},{"name":"Italy &amp; Israel Corporation","award":["3-16414"],"award-info":[{"award-number":["3-16414"]}]},{"name":"Italy &amp; Israel Corporation","award":["3-17927"],"award-info":[{"award-number":["3-17927"]}]},{"name":"Italy &amp; Israel Corporation","award":["311514"],"award-info":[{"award-number":["311514"]}]},{"name":"Italy &amp; Israel Corporation","award":["32-G-13427-2 (DM 1062\/2021)"],"award-info":[{"award-number":["32-G-13427-2 (DM 1062\/2021)"]}]},{"name":"Academy of Finland","award":["1873\/21"],"award-info":[{"award-number":["1873\/21"]}]},{"name":"Academy of Finland","award":["3-16414"],"award-info":[{"award-number":["3-16414"]}]},{"name":"Academy of Finland","award":["3-17927"],"award-info":[{"award-number":["3-17927"]}]},{"name":"Academy of Finland","award":["311514"],"award-info":[{"award-number":["311514"]}]},{"name":"Academy of Finland","award":["32-G-13427-2 (DM 1062\/2021)"],"award-info":[{"award-number":["32-G-13427-2 (DM 1062\/2021)"]}]},{"name":"Programma Operativo Nazionale (PON) Ricerca e Innovazione of the Italian Ministry of University and Research (MUR)","award":["1873\/21"],"award-info":[{"award-number":["1873\/21"]}]},{"name":"Programma Operativo Nazionale (PON) Ricerca e Innovazione of the Italian Ministry of University and Research (MUR)","award":["3-16414"],"award-info":[{"award-number":["3-16414"]}]},{"name":"Programma Operativo Nazionale (PON) Ricerca e Innovazione of the Italian Ministry of University and Research (MUR)","award":["3-17927"],"award-info":[{"award-number":["3-17927"]}]},{"name":"Programma Operativo Nazionale (PON) Ricerca e Innovazione of the Italian Ministry of University and Research (MUR)","award":["311514"],"award-info":[{"award-number":["311514"]}]},{"name":"Programma Operativo Nazionale (PON) Ricerca e Innovazione of the Italian Ministry of University and Research (MUR)","award":["32-G-13427-2 (DM 1062\/2021)"],"award-info":[{"award-number":["32-G-13427-2 (DM 1062\/2021)"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Brugada syndrome (BrS) is an inherited electrical cardiac disorder that is associated with a higher risk of ventricular fibrillation (VF) and sudden cardiac death (SCD) in patients without structural heart disease. The diagnosis is based on the documentation of the typical pattern in the electrocardiogram (ECG) characterized by a J-point elevation of \u22652 mm, coved-type ST-segment elevation, and negative T wave in one or more right precordial leads, called type 1 Brugada ECG. Risk stratification is particularly difficult in asymptomatic cases. Patients who have experienced documented VF are generally recommended to receive an implantable cardioverter defibrillator to lower the likelihood of sudden death due to recurrent episodes. However, for asymptomatic individuals, the most appropriate course of action remains uncertain. Accurate risk prediction is critical to avoiding premature deaths and unnecessary treatments. Due to the challenges associated with experimental research on human cardiac tissue, alternative techniques such as computational modeling and deep learning-based artificial intelligence (AI) are becoming increasingly important. This study introduces a vision transformer (ViT) model that leverages 12-lead ECG images to predict potentially fatal arrhythmic events in BrS patients. This dataset includes a total of 278 ECGs, belonging to 210 patients which have been diagnosed with Brugada syndrome, and it is split into two classes: event and no event. The event class contains 94 ECGs of patients with documented ventricular tachycardia, ventricular fibrillation, or sudden cardiac death, while the no event class is composed of 184 ECGs used as the control group. At first, the ViT is trained on a balanced dataset, achieving satisfactory results (89% accuracy, 94% specificity, 84% sensitivity, and 89% F1-score). Then, the discarded no event ECGs are attached to additional 30 event ECGs, extracted by a 24 h recording of a singular individual, composing a new test set. Finally, the use of an optimized classification threshold improves the predictions on an unbalanced set of data (74% accuracy, 95% negative predictive value, and 90% sensitivity), suggesting that the ECG signal can reveal key information for the risk stratification of patients with Brugada syndrome.<\/jats:p>","DOI":"10.3390\/s25030824","type":"journal-article","created":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T04:01:39Z","timestamp":1738209699000},"page":"824","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["A Vision Transformer Model for the Prediction of Fatal Arrhythmic Events in Patients with Brugada Syndrome"],"prefix":"10.3390","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3640-8561","authenticated-orcid":false,"given":"Vincenzo","family":"Randazzo","sequence":"first","affiliation":[{"name":"Department of Electronics and Telecommunications (DET), Politecnico di Torino, 10129 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8244-5335","authenticated-orcid":false,"given":"Silvia","family":"Caligari","sequence":"additional","affiliation":[{"name":"Department of Electronics and Telecommunications (DET), Politecnico di Torino, 10129 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2403-1683","authenticated-orcid":false,"given":"Eros","family":"Pasero","sequence":"additional","affiliation":[{"name":"Department of Electronics and Telecommunications (DET), Politecnico di Torino, 10129 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5102-3398","authenticated-orcid":false,"given":"Carla","family":"Giustetto","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Citt\u00e0 della Salute e della Scienza Hospital, 10126 Turin, Italy"},{"name":"Department of Medical Sciences, University of Turin, 10124 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9475-1507","authenticated-orcid":false,"given":"Andrea","family":"Saglietto","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Citt\u00e0 della Salute e della Scienza Hospital, 10126 Turin, Italy"},{"name":"Department of Medical Sciences, University of Turin, 10124 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Bertarello","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Citt\u00e0 della Salute e della Scienza Hospital, 10126 Turin, Italy"},{"name":"Department of Medical Sciences, University of Turin, 10124 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Averbuch","sequence":"additional","affiliation":[{"name":"School of Computer Science, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mira","family":"Marcus-Kalish","sequence":"additional","affiliation":[{"name":"Department of Statistics and Operations, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4606-2114","authenticated-orcid":false,"given":"Valery","family":"Zheludev","sequence":"additional","affiliation":[{"name":"School of Computer Science, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3178-6205","authenticated-orcid":false,"given":"Fiorenzo","family":"Gaita","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, University of Turin, 10124 Turin, Italy"},{"name":"J Medical, Cardiology Unit, 10151 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1016\/0735-1097(92)90253-J","article-title":"Right bundle branch block, persistent ST segment elevation and sudden cardiac death: A distinct clinical and electrocardiographic syndrome: A multicenter report","volume":"20","author":"Brugada","year":"1992","journal-title":"J. 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