Multi-Domain Quantitative ECG Analysis Reveals Distinct Morphological Patterns in Brugada Syndrome

Ziyu Li1, Dillon J Dzikowicz2, Ben Bailey1, Michael J Silka3, Junmo An1
1Philips, 2University of Rochester, 3Children's Hospital Los Angeles


Abstract

Brugada syndrome is associated with an increased risk of sudden cardiac death and is diagnosed primarily by visual assessment of ECG morphology in the right precordial leads. We evaluated whether automated quantitative ECG measurements could characterize the Brugada phenotype beyond conventional visual criteria. Standard 12-lead ECG recordings from the Brugada-HUCA database were analyzed, including 69 participants with Brugada syndrome and 287 controls. Automated measurements from representative beats were compared in leads V1 and V2 using Mann-Whitney rank-sum tests. Brugada syndrome was associated with higher STJ amplitude and more negative ST-segment slope in both leads. The J-Tpeak interval was significantly shorter in the Brugada group, whereas ST-segment duration did not differ significantly between groups. QRS area and T-wave area also differed significantly in both leads. Representative-beat analysis localized the principal morphological differences to the J-point, ST segment, and T-wave regions. These findings provide interpretable quantitative markers of the Brugada ECG phenotype that may complement visual ECG assessment and support future automated detection approaches.