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CLINICAL STUDY: ELECTROPHYSIOLOGY

The prevalence, incidence and prognostic value of the Brugada-type electrocardiogram

A population-based study of four decades

Kiyotaka Matsuo, MD^* , Masazumi Akahoshi, MD, Eiji Nakashima, PhD, Akihiko Suyama, MD, Shinji Seto, MD^*, Motonobu Hayano, MD^* and Katsusuke Yano, MD^*

^* Third Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
Radiation Effects Research Foundation, Nagasaki, Japan
Radiation Effects Research Foundation, Hiroshima, Japan

Manuscript received January 5, 2001; revised manuscript received April 5, 2001, accepted May 5, 2001.

Reprint requests and correspondence: Dr. Kiyotaka Matsuo, Third Department of Internal Medicine, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
matsuok{at}net.nagasaki-u.ac.jp

OBJECTIVES

We sought to demonstrate the prevalence, incidence and prognostic value of the Brugada-type electrocardiogram (ECG) in a general population.

BACKGROUND

The Brugada syndrome is characterized by evidence of right bundle branch block and ST segment elevation in the right precordial leads, as well as sudden death caused by ventricular fibrillation. However, the natural history of the Brugada-type ECG remains unclear.

METHODS

We investigated 4,788 subjects (1,956 men and 2,832 women) who were <50 years old in 1958 and had undergone biennial health examinations, including electrocardiography, through 1999. The Brugada-type ECG was defined as a terminal r' wave in lead V₁ and ST segment elevation 0.1 mV in leads V₁ and V₂. Unexpected death was defined as sudden death or unexplained accidental death.

RESULTS

There were a total of 32 Brugada-type ECG cases; the prevalence and incidence were 146.2 in 100,000 persons and 14.2 persons per 100,000 person-years, respectively. The incidence was nine times higher among men than women, and the average age at presentation was 45 ± 10.5 years. The Brugada-type ECG appeared intermittently in most cases and was found in 26% of subjects who died unexpectedly. Cox survival analysis revealed that mortality from unexpected death was significantly higher in subjects with a Brugada-type ECG than in control subjects (p < 0.01). Unexpected deaths were more frequent among subjects with the Brugada-type ECG who had a history of syncope (p < 0.05).

CONCLUSIONS

The Brugada-type ECG is not a very rare condition in the adult Japanese population. Subjects with a Brugada-type ECG have an increased risk of unexpected death.

Abbreviations and Acronyms   ECG = electrocardiogram   VF = ventricular fibrillation

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