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Background: An rSr' pattern in leads V1-V2 can be observed when ECG leads are placed in the 2nd intercostal space. Recently, three criteria analyzing the ST segment and r' width to identify true Brugada pattern ECGs have been described., Objectives: To assess the feasibility and reliability of using high precordial lead ECGs in conjunction with three new criteria for identifying true Brugada pattern ECGs., Methods: ECGs of 491 college athletes and 181 non-athletes were performed with standard and high-lead ECGs. ECGs were then analyzed using the newly proposed criteria., Results: Zero patients had a Brugada type 1 or 2 pattern at baseline; 76 patients demonstrated an rSr' pattern in leads V1-V2 on the high-lead ECG. Two of the 76 (3%) met criteria suggesting a true Brugada ECG., Conclusion: New ECG criteria based on the r' wave accurately identify rSr' patterns in V1-V2 from potential Brugada type 2 patterns in patients with purposely placed high precordial leads., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Importance: Rapidly detecting dangerous arrhythmias in a symptomatic athlete continues to be an elusive goal. The use of handheld smartphone electrocardiogram (ECG) monitors could represent a helpful tool connecting the athletic trainer to the cardiologist., Observations: Six college athletes presented to their athletic trainers complaining of palpitations during exercise. A single lead ECG was performed using the AliveCor Heart Monitor and sent wirelessly to the Team Cardiologist who confirmed an absence of dangerous arrhythmia., Conclusions and Relevance: AliveCor monitoring has the potential to enhance evaluation of symptomatic athletes by allowing trainers and team physicians to make diagnosis in real-time and facilitate faster return to play., (Copyright © 2015 Elsevier Inc. All rights reserved.)