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(Circulation. 1999;99:722-725.)
© 1999 American Heart Association, Inc.

Correspondence

Sudden Cardiac Death, RBBB, and Right Precordial ST-Segment Elevation

Arthur Wilde Donald Düren

Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, Heart Lung Institute, Utrecht, The Netherlands

To the Editor:

We have followed with interest the growing series of patients with the right bundle-branch block (RBBB) and right precordial ST-segment elevation ECG pattern. Beginning in 1992, Brugada and Brugada described 8 patients with this distinctive ECG pattern and a history of aborted sudden death.¹ The series was expanded to 47 patients in 1997, including 15 asymptomatic individuals in whom an abnormal ECG was found during routine screening (n=10) or during screening of relatives of an aborted sudden cardiac death victim (n=5).² The most recent expansion comprises 63 patients, including 22 asymptomatic individuals, 9 of whom were screened for family reasons.³ The incidence of serious ventricular arrhythmias was similar in symptomatic and asymptomatic individuals. Drug treatment proved ineffective, and accordingly, implantation of an automated implantable cardioverter-defibrillator (AICD) was advised as the treatment of choice in all patients identified by means of this ECG, regardless of their history.³

In 1960, the late Professor Dirk Durrer identified a male patient (46 years of age) with a saddle-type ST-segment elevation in leads V₁ through V₃. This patient, with a negative family history for sudden cardiac death, was followed up for almost 40 years. He never had any complaints. With the exception of an acute anteroseptal myocardial infarction (MI) in 1989, no structural heart disease could ever be demonstrated. The Figure shows some of the ECG recordings from this patient that were made over the years. An unstable elevated ST segment in the right precordial leads was accompanied by a gradual . . . [Full Text of this Article]

Josep Brugada

Cardiovascular Institute Hospital Clínic, University of Barcelona, Barcelona, Spain

Ramon Brugada

Cardiology Department Baylor College of Medicine, Houston, Tex

Pedro Brugada

Cardiovascular Center OLV Hospital, Aalst, Belgium

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