In order to compare the value of different leads and lead combinations to detect the signature Brugada type ECG pattern, we analysed digital 10-second, 15-lead ECGs (12 standard leads + leads V1 to V3 from 3rd intercostal (i.c.) space, V1h to V3h) acquired during diagnostic Ajmaline testing in 128 patients (80 men, age 37±15 years) with suspected Brugada syndrome (BS) (patient group), 15-lead resting ECGs of 108 healthy subjects (53 men, age 31.9±10.5 years) (control group A) and standard 12-lead resting ECGs of 229 healthy subjects (111 men, age 33±4 years) (control group B). Bipolar leads between V2 (positive pole) and V4 or V5 (leads V2-4V2-5) were derived by subtracting leads V4 and V5 from V2 (custom-made program). The 6 peripheral, 6 right precordial leads (V1 to V3, V1h to V3h) and leads V2-4 and V2-5 of the patients group, leads V1h to V3h of control group A, and leads V2-4 and V2-5 of control group B were analysed for the presence of type 1 Brugada pattern. There were 21 (16.4%) positive and 107 (83.6%) negative Ajmaline tests. In 7 positive tests (33%), type 1 pattern appeared only in leads V1h to V3h, whereas in 14 tests 67%) it appeared in both V1 to V3 and V1h to V3h. Lead V2 displayed type 1 pattern during 10 positive tests; in all of them, plus 10 other positive tests type 1 was also noted in lead V2h (n=20, 95.2%). In all 10 cases, in which lead V2 exhibited type 1 pattern (n=10), lead V2-4 and/or V2-5 also exhibited type 1-like pattern. During 7 positive tests, in which lead V2h but not V2 exhibited type 1 pattern, lead V2-4 and/or V2-5 also demonstrated type 1 pattern. Type 1 pattern was observed in leads V3 and V3h during 1 (5%) and 5 (24%) positive tests, in 0 ECGs (0%) in control group A and in 1 ECG (0.4%) in control group B. In conclusion, the "high" V1 and V2 leads (3rd i.c. space) detect more sensitively Brugada type 1 pattern than the standard V1 and V2 leads (4th i.c. space); leads V3 and V3h are not essential for the diagnosis of BS; bipolar leads V2-4 and V2-5 are superior to lead V2 for the ECG diagnosis of BS
