RT-243
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Right bundle branch block, st
segment elevation in leads V1-V3 and sudden cardiac death
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Josep Brugada, Ramon Brugada*,
Pedro Brugada**.
Arrhythmia Unit, Cardiovascular Institute, Hospital Clínic, University of Barcelona,
Spain,
*Cardiology Department, Baylor College of Medicine, Houston, USA,
**Cardiovascular Research and Teaching Institute, OLV Hospital, Aalst, Belgium
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Abstract
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Background. Five years ago we
described a specific electrocardiographic (ECG) pattern of right bundle branch block and
ST segment elevation in leads V1-V3 associated with sudden death in patients without
demonstrable structural heart disease. Since then information has become available from
several centers on patients with these characteristics.
Methods. Data on 63 patients (58 males, mean age 38 ± 17 years old)
with the described ECG pattern are presented. In 41 patients the abnormal
electrocardiogram was recognized after one episode of aborted sudden death or syncope of
unknown origin (symptomatic patients) and in 22 patients the ECG pattern was recognized by
chance or because of screening related to sudden death of a relative (asymptomatic
patients). In none of the patients structural heart disease could be demonstrated using
non-invasive and invasive tests. Electrocardiographic abnormalities changed over time and
could be modulated with administration of class I antiarrhythmic drugs. During a mean
follow-up of 34 ± 32 months, an arrhythmic event occurred in 14 symptomatic patients
(34%) and 6 asymptomatic patients (27%). An automatic defibrillator was implanted in 35
patients, 15 received pharmacological therapy with beta-blockers and/or amiodarone and 13
did not receive treatment. Total mortality was 0 in the implantable defibrillator group,
26% in the pharmacological group and 31% in the no therapy group (logrank 0.0005). All
mortality was caused by sudden death.
Conclusions. Patients without demonstrable structural heart disease
and an ECG pattern of right bundle branch block and ST segment elevation in leads V1-V3
are at risk for sudden death.
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Key Words
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Brugada, Martini-Nava syndromes
sudden death, middle-aged patients, right bundle branch block, right precordial ST segment
elevation, V1-V3 ECG leads, ventricular fibrillation, beta-blockers, amiodarone, ICD
indication, family ECG screening, OA
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