Prevalence and significance of Brugada-type ECG in 12,012 apparently healthy European subjects

Gallagher, Mark M.; Forleo, Giovanni B.; Behr, Elijah R.; Magliano, Giulia; Luca, Lucia De; Morgia, Valeria; Liberato, Fabio De; Romeo, Francesco

doi:10.1016/j.ijcard.2007.07.159

Cited by 86 publications

(46 citation statements)

References 31 publications

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“…In keeping with previous reports,4, 7, 9, 10, 21, 22 there was a male predominance among participants with BrS. In the present study, no SCD among participants with type 1 BrS and only 1 SCD among those with non–type 1 BrS was observed during the follow‐up period, which was consistent with previous community‐based studies,6, 8, 9, 12, 14 except for the Atomic Heart Study 11.…”

Section: Discussionsupporting

confidence: 92%

“…The data from previous studies vary regarding prevalence and prognosis for patients with Brugada‐type ECG (BrS) because of different populations (eg, general population, office workers),4, 5, 6, 7, 8, 9 different ECG definitions,5, 6, 9, 10, 11, 12 relatively short‐term follow‐up,5, 6, 9, 10, 12, 13 or poorly defined SCD 5, 6, 7, 8, 10, 11, 13, 14…”

Section: Introductionmentioning

confidence: 99%

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Long‐Term Prognosis of Brugada‐Type ECG and ECG With Atypical ST‐Segment Elevation in the Right Precordial Leads Over 20 Years: Results From the Circulatory Risk in Communities Study (CIRCS)

Tsuneoka

Takagi

Murakoshi

et al. 2016

JAHA

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BackgroundBrugada syndrome is recognized as being associated with sudden cardiac death; however, the prevalence of non–type 1 Brugada‐type ECG (BrS) or atypical ST‐segment elevation in the right precordial leads (STERP) and the long‐term prognosis for those patients remain unknown.Methods and ResultsWe analyzed standard 12‐lead ECGs of 7178 apparently healthy participants (age range 40–64 years) who underwent health checkups from 1982 to 1986 in the Circulatory Risk in Communities Study, a prospective, large, community‐based cohort study in Japan. ECGs with J point amplitude ≥0.2 mV in the right precordial leads were divided into 3 groups: (1) type 1 BrS, (2) type 2 or 3 BrS (non‐type 1 BrS), and (3) STERP. The others served as the non–ST‐segment elevation group. We identified 8 participants (0.1%) with type1 BrS, 84 (1.2%) with non–type 1 BrS, and 228 (3.2%) with STERP. During a median follow‐up of 18.7 years (133 987.0 person‐years), sudden cardiac death was observed in no participants (0.0%) with type 1 BrS, in 1 (1.2%) with non–type 1 BrS, in 7 (3.1%) with STERP, and in 50 (0.7%) with non–ST‐segment elevation. Participants with STERP had a markedly elevated risk of sudden cardiac death (multivariable hazard ratio 3.9, 95% CI 1.7–9.0).Conclusions STERP was associated with an elevated risk of sudden cardiac death in a middle‐aged population.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Long‐Term Prognosis of Brugada‐Type ECG and ECG With Atypical ST‐Segment Elevation in the Right Precordial Leads Over 20 Years: Results From the Circulatory Risk in Communities Study (CIRCS)

Tsuneoka

Takagi

Murakoshi

et al. 2016

JAHA

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“…A type I Brugada ECG pattern is found rarely in the European population, but it appears more commonly in Southeast Asia, with an estimated prevalence of 0.12% in Japan. 9,10 No apparent structural heart disease can be found in BrS, at least macroscopically. Some microscopic myocardial alterations have been reported, suggesting that the channelopathy may induce cardiomyopathic changes in some patients.…”

Section: Clinical Diagnosis Diagnostic Criteriamentioning

confidence: 99%

Brugada syndrome: clinical and genetic findings

Sarquella-Brugada

Campuzano

Arbelo

et al. 2016

Genetics in Medicine

125

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Review ARticleMore than 20 years ago, eight individuals were resuscitated from sudden cardiac death (SCD) caused by documented ventricular fibrillation (VF); all showed a characteristic ST segment elevation in the right precordial leads and a structurally normal heart. 1 In 1996, the term "Brugada syndrome" (BrS) was used to describe what was previously known as "right bundle branch block, persistent ST segment elevation, and sudden death syndrome. " 2 A year later, BrS was reported to be the same disease as sudden unexplained nocturnal death syndrome (SUNDS). In other countries, BrS has different names: Lai Tai (Thailand), Pokkuri (Japan), and Bangungut (Philippines). Currently, the prevalence of BrS is estimated at ~3-5 in 10,000 people, and it is higher in young men of Southeast Asian origin. It is the main cause of death among young healthy men in Southeast Asia. 3 Recent reports suggest that BrS could be responsible for 4% of all SCD and up to 12% of sudden death in patients with structurally normal hearts. The clinical phenotype manifests in adulthood, at a mean age of 41 years, and it is 8-to 10-times more frequent in males. Frequently, sudden death can be the first manifestation of the disease. 4 In 1998, the genetic basis of BrS was established when the sodium channel protein type V subunit α gene (SCN5A), which encodes the α-subunit of the voltage-gated Na v 1.5 cardiac sodium channel responsible for regulating rapid sodium current (I Na ), was associated with the disease. 5 Currently, BrS is recognized as a rare, inherited cardiac channelopathy caused by an alteration of ionic currents that leads to ventricular arrhythmias and SCD. It is clinically characterized by ST segment elevation in leads V1-V3 of the electrocardiogram, but incomplete penetrance and variable expressivity confound the diagnosis. 6 Despite the identification of 18 associated genes, 65-70% of clinically diagnosed cases remain without an identifiable genetic cause. 4 CLINICAL DIAGNOSIS Diagnostic criteriaThe clinical diagnosis of BrS requires the identification of the ST segment elevation in the right precordial leads at baseline or after the use of sodium blockers. Three different electrocardiographic (ECG) patterns can be often observed in families with BrS: type I, which consists of a coved-type ST segment elevation greater than 2 mm followed by a descending negative T wave in at least two right precordial leads (V1 to V3); type II ST elevation, saddleback-shaped patterns with a high initial increase followed by an ST elevation greater than 2 mm; and saddleback-shaped patterns with a high initial increase followed by an ST elevation less than 2 mm (Figure 1). The second Brugada Consensus Report proposed that only type I is diagnostic for BrS 7 and, in 2013, it was proposed that a definitive diagnosis of BrS considers both spontaneous type I pattern and a provoked type I pattern (with a baseline type II or III pattern) in at least one right precordial lead (V1 or V2). 8 The diagnosis of BrS is currently accepted in those patients ...

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“…Type 1 ECG appears more frequently in Asia (0%-0.36%) [55][56][57][58][59][60][61][62][63][64][65][66] and Europe (0%-0.25%) [67][68][69][70][71][72][73][74] than in the United States (0.03%). [75][76][77][78][79] Type 2 and type 3 ECG is more prevalent in Asia (0.12%-2.23%) [56][57][58][59][60][61][62][63][64][65][66] than in Europe (0.0%-0.6%) [67][68][69][70][71][72][73][74] or the United States (0.02%). [76][77][78][79] The low prevalence of Brugada-type ECG in the United States may be explained by different ethnic backgrounds among the studies.…”

Section: Clinical Presentation Demographic Datamentioning

confidence: 99%