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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 )

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ABSTRACT

Background: Brugada 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 results: We 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.

No MeSH data available.


Representative ECG tracings of the type 1 Brugada‐type ECG (BrS), non–type 1 BrS, atypical ST‐segment elevation in the right precordial leads (STERP), and non–ST‐segment elevation (non‐ST) groups. Type 1 BrS (A) is characterized by prominent coved ST‐segment elevation displaying a J point amplitude ≥0.2 mV at its peak, followed by a negative T wave. Non–type 1 BrS (B and C) also has high takeoff ST‐segment elevation, but in this case, the J point amplitude (≥0.2 mV) gives rise to a gradually descending ST‐segment elevation followed by a positive or biphasic T wave that results in a saddleback configuration. STERP (D and E) shows noncoved and nonsaddleback ST‐T morphology with J point elevation ≥0.2 mV in the right precordial leads. F, J point elevation of <0.2 mV in the right precordial leads is included in the non‐ST group.
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jah31680-fig-0002: Representative ECG tracings of the type 1 Brugada‐type ECG (BrS), non–type 1 BrS, atypical ST‐segment elevation in the right precordial leads (STERP), and non–ST‐segment elevation (non‐ST) groups. Type 1 BrS (A) is characterized by prominent coved ST‐segment elevation displaying a J point amplitude ≥0.2 mV at its peak, followed by a negative T wave. Non–type 1 BrS (B and C) also has high takeoff ST‐segment elevation, but in this case, the J point amplitude (≥0.2 mV) gives rise to a gradually descending ST‐segment elevation followed by a positive or biphasic T wave that results in a saddleback configuration. STERP (D and E) shows noncoved and nonsaddleback ST‐T morphology with J point elevation ≥0.2 mV in the right precordial leads. F, J point elevation of <0.2 mV in the right precordial leads is included in the non‐ST group.

Mentions: The types of BrS were classified according to the ECG criteria described in the report of the second consensus conference, which defined type 1 as characterized by a coved‐type J point elevation ≥2 mm (0.2 mV) and non–type 1 as characterized by type 2 or 3 BrS ECG, that is, a saddleback‐type J point elevation ≥2 mm (0.2 mV).3 Patients who had ECGs with J point elevation ≥0.2 mV in the right precordial leads and non‐BrS ECG were categorized as having STERP. Other ECGs were classified as non–ST‐segment elevation (non‐ST). Consequently, ECGs in this study were categorized into 4 groups: type1 BrS (Figure 2A), non–type 1 BrS (Figure 2B and 2C), STERP (Figure 2D and 2E), and non‐ST (Figure 2F).


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 )
Representative ECG tracings of the type 1 Brugada‐type ECG (BrS), non–type 1 BrS, atypical ST‐segment elevation in the right precordial leads (STERP), and non–ST‐segment elevation (non‐ST) groups. Type 1 BrS (A) is characterized by prominent coved ST‐segment elevation displaying a J point amplitude ≥0.2 mV at its peak, followed by a negative T wave. Non–type 1 BrS (B and C) also has high takeoff ST‐segment elevation, but in this case, the J point amplitude (≥0.2 mV) gives rise to a gradually descending ST‐segment elevation followed by a positive or biphasic T wave that results in a saddleback configuration. STERP (D and E) shows noncoved and nonsaddleback ST‐T morphology with J point elevation ≥0.2 mV in the right precordial leads. F, J point elevation of <0.2 mV in the right precordial leads is included in the non‐ST group.
© Copyright Policy - creativeCommonsBy-nc
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC5015268&req=5

jah31680-fig-0002: Representative ECG tracings of the type 1 Brugada‐type ECG (BrS), non–type 1 BrS, atypical ST‐segment elevation in the right precordial leads (STERP), and non–ST‐segment elevation (non‐ST) groups. Type 1 BrS (A) is characterized by prominent coved ST‐segment elevation displaying a J point amplitude ≥0.2 mV at its peak, followed by a negative T wave. Non–type 1 BrS (B and C) also has high takeoff ST‐segment elevation, but in this case, the J point amplitude (≥0.2 mV) gives rise to a gradually descending ST‐segment elevation followed by a positive or biphasic T wave that results in a saddleback configuration. STERP (D and E) shows noncoved and nonsaddleback ST‐T morphology with J point elevation ≥0.2 mV in the right precordial leads. F, J point elevation of <0.2 mV in the right precordial leads is included in the non‐ST group.
Mentions: The types of BrS were classified according to the ECG criteria described in the report of the second consensus conference, which defined type 1 as characterized by a coved‐type J point elevation ≥2 mm (0.2 mV) and non–type 1 as characterized by type 2 or 3 BrS ECG, that is, a saddleback‐type J point elevation ≥2 mm (0.2 mV).3 Patients who had ECGs with J point elevation ≥0.2 mV in the right precordial leads and non‐BrS ECG were categorized as having STERP. Other ECGs were classified as non–ST‐segment elevation (non‐ST). Consequently, ECGs in this study were categorized into 4 groups: type1 BrS (Figure 2A), non–type 1 BrS (Figure 2B and 2C), STERP (Figure 2D and 2E), and non‐ST (Figure 2F).

View Article: PubMed Central - PubMed

ABSTRACT

Background: Brugada syndrome is recognized as being associated with sudden cardiac death; however, the prevalence of non&ndash;type 1 Brugada&#8208;type ECG (BrS) or atypical ST&#8208;segment elevation in the right precordial leads (STERP) and the long&#8208;term prognosis for those patients remain unknown.

Methods and results: We analyzed standard 12&#8208;lead ECGs of 7178 apparently healthy participants (age range 40&ndash;64&nbsp;years) who underwent health checkups from 1982 to 1986 in the Circulatory Risk in Communities Study, a prospective, large, community&#8208;based cohort study in Japan. ECGs with J point amplitude &ge;0.2&nbsp;mV in the right precordial leads were divided into 3 groups: (1) type 1 BrS, (2) type 2 or 3 BrS (non&#8208;type 1 BrS), and (3) STERP. The others served as the non&ndash;ST&#8208;segment elevation group. We identified 8 participants (0.1%) with type1 BrS, 84 (1.2%) with non&ndash;type 1 BrS, and 228 (3.2%) with STERP. During a median follow&#8208;up of 18.7&nbsp;years (133 987.0&nbsp;person&#8208;years), sudden cardiac death was observed in no participants (0.0%) with type 1 BrS, in 1 (1.2%) with non&ndash;type 1 BrS, in 7 (3.1%) with STERP, and in 50 (0.7%) with non&ndash;ST&#8208;segment elevation. Participants with STERP had a markedly elevated risk of sudden cardiac death (multivariable hazard ratio 3.9, 95% CI 1.7&ndash;9.0).

Conclusions: STERP was associated with an elevated risk of sudden cardiac death in a middle&#8208;aged population.

No MeSH data available.