Right bundle branch block, right precordial st-segment elevation, and sudden death in young people.
BACKGROUND
Patients with the ECG pattern of right bundle branch block and right precordial ST-segment elevation may experience sudden death in the setting of either arrhythmogenic right ventricular cardiomyopathy (ARVC) or a functional electrical disorder such as Brugada syndrome.


RESULTS
Among a series of 273 young (</=35 years) victims of cardiovascular sudden death who were prospectively studied from 1979 to 1998 in the Veneto Region of Italy, 12-lead ECG was available in 96 cases. Thirteen (14%; 12 males and 1 female aged 24+/-8 years) had right precordial ST-segment elevation, either isolated (9 cases) or associated with right bundle branch block (4 cases). At autopsy, all patients had ARVC (92%) except one, who had no evidence of structural heart disease. Compared with the 19 young sudden death victims with ARVC and no ST-segment abnormalities from the same series, those with AVRC and right precordial ST-segment elevation included fewer competitive athletes (17% versus 58%; P:=0.03), more often died suddenly at rest or during sleep (83% versus 26%; P:=0.003), and showed serial ECG changes over time (83% versus 0; P:=0.015), polymorphic ventricular tachycardia (33% versus 0; P:=0.016), and predominant fatty replacement of the right ventricular anterior wall (58% versus 21%; P:=0.05),


CONCLUSIONS
Right precordial ST-segment elevation was found in 14% of young sudden death victims with available ECG. It mostly reflected underlying ARVC with predominant right ventricular anterior wall involvement and characterized a subgroup of patients who share with Brugada patients the propensity to die from non-exercise-related cardiac arrest and to exhibit dynamic ECG changes and polymorphic ventricular tachycardia.
Corrado
D
D
Department of Cardiology, University of Padua Medical School, Padua, Italy.
Basso
C
C
Buja
G
G
Nava
A
A
Rossi
L
L
Thiene
G
G
D000328:Adult; D001145:Arrhythmias, Cardiac / Q000209:etiology; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000401:mortality* / Q000503:physiopathology; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000473:pathology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D015995:Prevalence