Published online before print January 10, 2005, doi: 10.1161/01.CIR.0000153267.21278.8D
(Circulation. 2005;111:257-263.)
© 2005 American Heart Association, Inc.
Arrhythmia/Electrophysiology |
Long-Term Prognosis of Individuals With Right Precordial ST-Segment–Elevation Brugada Syndrome
From the Westfälische Wilhelms University Hospital, Department of Cardiology and Angiology, Münster, Germany (L.E., E.S.B., T.W., G.B., D.B.); University Hospital, Department of Cardiology, Nantes, France (V.P., H.L.); INSERM U533, University of Nantes, Nantes, France (V.P., P.B., H.L.); Experimental and Molecular Cardiology Group, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (J.P.P.S., A.A.M.W.); University Hospital Mannheim, University of Heidelberg, Mannheim, Germany (C.W., R.S., M.B.); and Department of Medical Informatics and Biomathematics, University of Münster, Münster, Germany.
Correspondence to PD Dr Lars Eckardt, Universitätsklinikum Münster Medizinische Klinik und Poliklinik C, Kardiologie und Angiologie, Albert Schweitzer Str 33, D-48149 Münster, Germany. E-mail l.eckardt{at}uni-muenster.de
Received June 17, 2004; revision received September 29, 2004; accepted October 11, 2004.
Background— Brugada syndrome is an arrhythmogenic disease characterized by an ECG pattern of ST-segment elevation in the right precordial leads and an increased risk of sudden cardiac death as a result of ventricular fibrillation. Controversy exists with regard to risk stratification and therapeutic management, particularly in asymptomatic individuals.
Methods and Results— A total of 212 individuals (mean age, 45±6 years) with a type 1 Brugada ECG pattern were studied. Of these, 123 (58%) were asymptomatic, 65 (31%) had 
1 syncope of unknown origin, and 24 (11%) had to be resuscitated because of ventricular fibrillation. In 125 individuals (59%), a spontaneous type 1 ECG was recorded. In the remaining, drug challenge with a class I antiarrhythmic agent unmasked a Brugada ECG. The mean ST elevation was 2.3±1.2 mm in symptomatic patients and 1.9±1.5 mm in asymptomatic individuals (P=0.04). During a mean follow-up of 40±50 months, 4 of the 24 patients (17%) with aborted sudden cardiac death and 4 of 65 (6%) with a prior syncope had a recurrent arrhythmic event, whereas only 1 of 123 asymptomatic individuals (0.8%) had a first arrhythmic event. Four of 9 patients with arrhythmic events during follow-up were not inducible during programmed electrical stimulation. A previous history of aborted sudden death or syncope and the presence of a spontaneous type 1 ECG were predictors of adverse outcome.
Conclusions— The present study reports data on a large population of individuals with a type 1 Brugada ECG pattern with the longest follow-up reported so far. A very low incidence of severe arrhythmic events, particularly in asymptomatic individuals, was found during follow-up. In the presence of very few arrhythmic events on follow-up, programmed electrical stimulation showed very little accuracy in predicting outcome.
Key Words: death, sudden • fibrillation • electrocardiography • genetics • risk factors
This article has been cited by other articles:
 |
|
 |
|
  S. Kamakura, T. Ohe, K. Nakazawa, Y. Aizawa, A. Shimizu, M. Horie, S. Ogawa, K. Okumura, K. Tsuchihashi, K. Sugi, et al. Long-Term Prognosis of Probands With Brugada-Pattern ST-Elevation in Leads V1-V3 Circ Arrhythm Electrophysiol, October 1, 2009; 2(5): 495 - 503. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Veltmann, C. Wolpert, F. Sacher, P. Mabo, R. Schimpf, F. Streitner, J. Brade, F. Kyndt, J. Kuschyk, H. Le Marec, et al. Response to intravenous ajmaline: a retrospective analysis of 677 ajmaline challenges Europace, October 1, 2009; 11(10): 1345 - 1352. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Probst and H. Le Marec Brugada syndrome: where are you? Europace, October 1, 2009; 11(10): 1260 - 1261. [Full Text] [PDF]
|
|
|
|
|
|
C. Veltmann, C. Wolpert, R. Schimpf, P. Mabo, H. LeMarec, M. Borggrefe, and V. Probst The ajmaline challenge and a strange ECG: reply Europace, October 1, 2009; 11(10): 1406 - 1407. [Full Text] [PDF]
|
|
|
|
|
|
C. Giustetto, S. Drago, P. G. Demarchi, P. Dalmasso, F. Bianchi, A. S. Masi, P. Carvalho, E. Occhetta, G. Rossetti, R. Riccardi, et al. Risk stratification of the patients with Brugada type electrocardiogram: a community-based prospective study Europace, April 1, 2009; 11(4): 507 - 513. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Surawicz, R. Childers, B. J. Deal, and L. S. Gettes AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram: Part III: Intraventricular Conduction Disturbances A Scientific Statement From the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society Endorsed by the International Society for Computerized Electrocardiology J. Am. Coll. Cardiol., March 17, 2009; 53(11): 976 - 981. [Full Text] [PDF]
|
|
|
|
 |
|
 B. Surawicz, R. Childers, B. J. Deal, and L. S. Gettes AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram: Part III: Intraventricular Conduction Disturbances: A Scientific Statement From the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: Endorsed by the International Society for Computerized Electrocardiology Circulation, March 17, 2009; 119(10): e235 - e240. [Full Text] [PDF]
|
|
|
|
 |
|
 S. W Dubrey, S. K Kohli, P. A Mehta, and R. Grocott-Mason An unusual case of palpitations BMJ, February 11, 2009; 338(feb11_2): a3087 - a3087. [Full Text]
|
|
|
|
 |
|
 S. G. Priori, C. Napolitano, S. E. Humphries, and J. Skipworth CHAPTER 9 Genetics of Cardiovascular Diseases ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Eckardt, G&#x.;n. Breithardt, and S. Hohnloser CHAPTER 30 Ventricular Tachycardia and Sudden Cardiac Death ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Benito, A. Sarkozy, L. Mont, S. Henkens, A. Berruezo, D. Tamborero, D. Arzamendi, P. Berne, R. Brugada, P. Brugada, et al. Gender Differences in Clinical Manifestations of Brugada Syndrome J. Am. Coll. Cardiol., November 4, 2008; 52(19): 1567 - 1573. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Francis and C. Antzelevitch Atrial Fibrillation and Brugada Syndrome J. Am. Coll. Cardiol., March 25, 2008; 51(12): 1149 - 1153. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Sarkozy, T. Boussy, G. Kourgiannides, G.-B. Chierchia, S. Richter, T. De Potter, P. Geelen, F. Wellens, M. D. Spreeuwenberg, and P. Brugada Long-term follow-up of primary prophylactic implantable cardioverter-defibrillator therapy in Brugada syndrome: reply Eur. Heart J., November 2, 2007; 28(22): 2820 - 2821. [Full Text] [PDF]
|
|
|
|
|
|
K. P. Letsas, G. Gavrielatos, M. Efremidis, S. P. Kounas, G. S. Filippatos, A. Sideris, and F. Kardaras Prevalence of Brugada sign in a Greek tertiary hospital population Europace, November 1, 2007; 9(11): 1077 - 1080. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Paul, J. Gerss, E. Schulze-Bahr, T. Wichter, C. Vahlhaus, A. A.M. Wilde, G. Breithardt, and L. Eckardt Role of programmed ventricular stimulation in patients with Brugada syndrome: a meta-analysis of worldwide published data Eur. Heart J., September 1, 2007; 28(17): 2126 - 2133. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Viskin and O. Rogowski Asymptomatic Brugada syndrome: a cardiac ticking time-bomb? Europace, September 1, 2007; 9(9): 707 - 710. [Full Text] [PDF]
|
|
|
|
|
|
S. Viskin Brugada Syndrome in Children: Don't Ask, Don't Tell? Circulation, April 17, 2007; 115(15): 1970 - 1972. [Full Text] [PDF]
|
|
|
|
|
|
V. Probst, I. Denjoy, P. G. Meregalli, J.-C. Amirault, F. Sacher, J. Mansourati, D. Babuty, E. Villain, J. Victor, J.-J. Schott, et al. Clinical Aspects and Prognosis of Brugada Syndrome in Children Circulation, April 17, 2007; 115(15): 2042 - 2048. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Sacher, V. Probst, Y. Iesaka, P. Jacon, J. Laborderie, F. Mizon-Gerard, P. Mabo, S. Reuter, D. Lamaison, Y. Takahashi, et al. Outcome After Implantation of a Cardioverter-Defibrillator in Patients With Brugada Syndrome: A Multicenter Study Circulation, November 28, 2006; 114(22): 2317 - 2324. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Veltmann, R. Schimpf, C. Echternach, L. Eckardt, J. Kuschyk, F. Streitner, S. Spehl, M. Borggrefe, and C. Wolpert A prospective study on spontaneous fluctuations between diagnostic and non-diagnostic ECGs in Brugada syndrome: implications for correct phenotyping and risk stratification Eur. Heart J., November 1, 2006; 27(21): 2544 - 2552. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Schulze-Bahr Arrhythmia Predisposition: Between Rare Disease Paradigms and Common Ion Channel Gene Variants J. Am. Coll. Cardiol., October 27, 2006; 48(9_Suppl_A): A67 - A78. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Teijeiro, H. A. Garro, R. S. Acunzo, E. Albino, and P. A. Chiale Recording of High V1-V3 Precordial Leads May Be Essential to the Diagnosis of Brugada Syndrome During the Ajmaline Test Journal of Cardiovascular Pharmacology and Therapeutics, June 1, 2006; 11(2): 153 - 155. [Abstract] [PDF]
|
|
|
|
|
|
J. Castro Hevia, C. Antzelevitch, F. Tornes Barzaga, M. Dorantes Sanchez, F. Dorticos Balea, R. Zayas Molina, M. A. Quinones Perez, and Y. Fayad Rodriguez Tpeak-Tend and Tpeak-Tend Dispersion as Risk Factors for Ventricular Tachycardia/Ventricular Fibrillation in Patients With the Brugada Syndrome J. Am. Coll. Cardiol., May 2, 2006; 47(9): 1828 - 1834. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L Eckardt, G Breithardt, and P Kirchhof Approach to wide complex tachycardias in patients without structural heart disease. Heart, May 1, 2006; 92(5): 704 - 711. [Full Text] [PDF]
|
|
|
|
|
|
P. Brugada, R. Brugada, J. Brugada, S. G. Priori, C. Napolitano, P. Brugada, R. Brugada, J. Brugada, S. G. Priori, and C. Napolitano Should patients with an asymptomatic Brugada electrocardiogram undergo pharmacological and electrophysiological testing? Circulation, July 12, 2005; 112(2): 279 - 292. [Full Text] [PDF]
|
|
|
|
 |
|
 Asymptomatic Brugada Syndrome Poses Minimal Short-Term Risk Journal Watch Emergency Medicine, March 16, 2005; 2005(316): 4 - 4. [Full Text]
|
|