From the Arrhythmia Unit (J.B.), Cardiovascular Institute, Hospital
Clínic, University of Barcelona, Spain; Cardiology Department (R.B.),
Baylor College of Medicine, Houston, Tex; and Cardiovascular Research and
Teaching Institute (P.B.), OLV Hospital, Aalst, Belgium.
Correspondence to Josep Brugada, MD, Arrhythmia Unit, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain. E-mail jepbrugada{at}grn.es
Background—Five years ago, we
described a specific ECG pattern of right bundle-branch block and
ST-segment elevation in leads V1 through V3
associated with sudden death in patients without demonstrable
structural heart disease. Information on long-term outcome has become
available due to pooled data on a large cohort of patients with this
syndrome who are followed at 33 centers worldwide.
Methods and Results—Data on 63 patients (57 men; mean age,
38±17 years) with the described ECG pattern were analyzed in
terms of arrhythmic events and sudden death. Events were
analyzed for patients with at least one episode of aborted
sudden death or syncope of unknown origin before recognition of the
syndrome (symptomatic patients, n=41) and for patients in
whom the ECG pattern was recognized by chance or because of screening
related to sudden death of a relative (asymptomatic
patients, n=22). During a mean follow-up of 34±32 months, an
arrhythmic event occurred in 14 symptomatic patients (34%)
and 6 asymptomatic patients (27%). An automatic
defibrillator was implanted in 35 patients, 15 received pharmacological
therapy with ß-blockers and/or amiodarone, and 13 did not
receive treatment The incidence of arrhythmic events was similar in all
therapy groups (log-rank 0.86); however, total mortality was 0% in the
implantable defibrillator group, 26% in the pharmacological group, and
31% in the no therapy group (log-rank 0.0005). All mortality was due
to sudden death.
Conclusions—Patients without demonstrable structural heart
disease and an ECG pattern of right bundle-branch block and ST-segment
elevation in leads V1 through V3 are at risk
for sudden death. Amiodarone and/or ß-blockers do not protect
them against sudden death, and an implantable defibrillator seems to be
the present treatment of choice.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Right Bundle-Branch Block and ST-Segment Elevation in Leads V1 Through V3
A Marker for Sudden Death in Patients Without Demonstrable Structural Heart Disease
Key Words: death, sudden • electrocardiography • fibrillation
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