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Original Articles

Long-Term Prognosis of Probands With Brugada-Pattern ST-Elevation in Leads V₁–V₃

Shiro Kamakura, MD, PhD; Tohru Ohe, MD, PhD; Kiyoshi Nakazawa, MD, PhD; Yoshifusa Aizawa, MD, PhD; Akihiko Shimizu, MD, PhD; Minoru Horie, MD, PhD; Satoshi Ogawa, MD, PhD; Ken Okumura, MD, PhD; Kazufumi Tsuchihashi, MD, PhD; Kaoru Sugi, MD, PhD; Naomasa Makita, MD, PhD; Nobuhisa Hagiwara, MD, PhD; Hiroshi Inoue, MD, PhD; Hirotsugu Atarashi, MD, PhD; Naohiko Aihara, MD; Wataru Shimizu, MD, PhD; Takashi Kurita, MD, PhD; Kazuhiro Suyama, MD, PhD; Takashi Noda, MD, PhD; Kazuhiro Satomi, MD, PhD; Hideo Okamura, MD; Hitonobu Tomoike, MD, PhD for the Brugada Syndrome Investigators in Japan

From the Division of Cardiology (S.K., N.A., W.S., T.K., K.S., T.N., K.S., H.O., H.T.), National Cardiovascular Center, Suita, Japan; the Department of Cardiovascular Medicine (T.O.), Okayama University Graduate School of Medicine, Okayama, Japan; the Department of Cardiology (K.N.), St Marianna University, Kawasaki, Japan; the Division of Cardiology (Y.A.), Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; the Division of Cardiology (A.S.), Yamaguchi University Graduate School of Medicine, Ube, Japan; the Department of Cardiovascular Medicine (M.H.), Shiga University of Medical Science, Otsu, Japan; the Department of Cardiopulmonary Medicine (S.O.), Keio University, Tokyo, Japan; the Second Department of Internal Medicine (K.O.), Hirosaki University School of Medicine, Hirosaki, Japan; the Second Department of Internal Medicine (K.T.), Sapporo Medical University School of Medicine, Sapporo, Japan; the Division of Cardiovascular Medicine (K.S.), Toho University Medical Center Ohashi Hospital, Tokyo, Japan; the Department of Cardiovascular Medicine (N.M.), Hokkaido University Graduate School of Medicine, Sapporo, Japan; the Department of Cardiology (N.H.), Tokyo Women’s Medical University; the Second Department of Internal Medicine (H.I.), Toyama University, Toyama, Japan; and the Department of Internal Medicine, Nippon Medical School, Tama-Nagayama Hospital, Tokyo, Japan.

Correspondence to Shiro Kamakura, MD, PhD, Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan. E-mail kamakura{at}hsp.ncvc.go.jp

Received August 22, 2008; accepted July 14, 2009.

Background— The prognosis of patients with saddleback or noncoved type (non–type 1) ST-elevation in Brugada syndrome is unknown. The purpose of this study was to clarify the long-term prognosis of probands with non–type 1 ECG and those with coved (type 1) Brugada-pattern ECG.

Methods and Results— A total of 330 (123 symptomatic, 207 asymptomatic) probands with a coved or saddleback ST-elevation 1 mm in leads V₁–V₃ were divided into 2 ECG groups—type 1 (245 probands) and non–type 1 (85 probands)—and were prospectively followed for 48.7±15.0 months. The absence of type 1 ECG was confirmed by drug provocation test and multiple recordings. The ratio of individuals with a family history of sudden cardiac death (14%) was lower than previous studies. Clinical profiles and outcomes were not notably different between the 2 groups (annual arrhythmic event rate of probands with ventricular fibrillation; type 1: 10.2%, non–type 1: 10.6%, probands with syncope; type 1: 0.6%, non–type 1: 1.2%, and asymptomatic probands; type 1: 0.5%, non–type 1: 0%). Family history of sudden cardiac death at age <45 years and coexistence of inferolateral early repolarization with Brugada-pattern ECG were independent predictors of fatal arrhythmic events (hazard ratio, 3.28; 95% confidence interval, 1.42 to 7.60; P=0.005; hazard ratio, 2.66; 95% confidence interval, 1.06 to 6.71; P=0.03, respectively, by multivariate analysis), although spontaneous type 1 ECG and ventricular fibrillation inducibility by electrophysiological study were not reliable parameters.

Conclusions— The long-term prognosis of probands in non–type 1 group was similar to that of type 1 group. Family history of sudden cardiac death and the presence of early repolarization were predictors of poor outcome in this study, which included only probands with Brugada-pattern ST-elevation.

Key Words: death, sudden • prognosis • follow-up studies • electrocardiography • Brugada syndrome

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