title: Long-term prognosis of individuals with right precordial ST-segment-elevation Brugada syndrome.
abstract: 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.
  
  
  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 > or =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.
authors.affiliation: Westfälische Wilhelms University Hospital, Department of Cardiology and Angiology, Münster, Germany. l.eckardt@uni-muenster.de
authors.forename: Lars
authors.initials: L
authors.lastname: Eckardt
authors.forename: Vincent
authors.initials: V
authors.lastname: Probst
authors.forename: Jeroen P P
authors.initials: JP
authors.lastname: Smits
authors.forename: Eric Schulze
authors.initials: ES
authors.lastname: Bahr
authors.forename: Christian
authors.initials: C
authors.lastname: Wolpert
authors.forename: Rainer
authors.initials: R
authors.lastname: Schimpf
authors.forename: Thomas
authors.initials: T
authors.lastname: Wichter
authors.forename: Pierre
authors.initials: P
authors.lastname: Boisseau
authors.forename: Achim
authors.initials: A
authors.lastname: Heinecke
authors.forename: Günter
authors.initials: G
authors.lastname: Breithardt
authors.forename: Martin
authors.initials: M
authors.lastname: Borggrefe
authors.forename: Herve
authors.initials: H
authors.lastname: LeMarec
authors.forename: Dirk
authors.initials: D
authors.lastname: Böcker
authors.forename: Arthur A M
authors.initials: AA
authors.lastname: Wilde
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002037:Bundle-Branch Block / Q000175:diagnosis* / Q000235:genetics / Q000503:physiopathology; D002648:Child; D004558:Electric Stimulation; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D062554:NAV1.5 Voltage-Gated Sodium Channel; D011379:Prognosis; D026941:Sodium Channel Blockers; D015222:Sodium Channels / Q000235:genetics
chemical_list: D062554:NAV1.5 Voltage-Gated Sodium Channel; C568320:SCN5A protein, human; D026941:Sodium Channel Blockers; D015222:Sodium Channels