Long-term prognosis of individuals with right precordial ST-segment-elevation Brugada syndrome

Article

关键词: BUNDLE-BRANCH BLOCK;    SUDDEN CARDIAC DEATH;    ELECTROCARDIOGRAPHIC PATTERN;    VENTRICULAR-FIBRILLATION;    FOLLOW-UP;   

DOI  :  10.1161/01.CIR.0000153267.21278.8D

来源: SCIE

【 摘 要 】

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 greater than or equal to 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.

【 授权许可】

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