Characteristics of patients with right bundle branch block and ST-segment elevation in right precordial leads

doi:10.1016/S0002-9149(96)00360-8

The American Journal of Cardiology

Volume 78, Issue 5, 1 September 1996, Pages 581-583

https://doi.org/10.1016/S0002-9149(96)00360-8 Get rights and content

Abstract

A coved ST elevation may be a warning sign of lethal ventricular arrhythmia. Contributions of the autonomic nervous system and of hereditary factors were suggested in the pathophysiology of this syndrome.

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The Human Genome Project has revolutionized medicine. Since its completion in 2003, the number of identified genetic mutations causing various disorders, including those of the cardiovascular system, has grown rapidly. Among these are the relatively common hypertrophic cardiomyopathy, connective tissue disorders such as Marfan syndrome or Loeys–Dietz syndrome, cardiac arrhythmia disorders including long-QT syndrome and Brugada syndrome, and an increasing number of defects predisposing to atherosclerosis, which itself may lead to stroke, myocardial infarction, and premature death. Genetic mutations leading to specific biochemical and physiological traits may be directly causative for certain disorders, or they may contribute to their pathogenesis. Our knowledge of pathological and biochemical changes brought on by genetic mutations is growing increasingly faster and will continue to grow in the coming years.
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We report on the use of Somastosensory Evoked Potential (SSEP) and Motor Evoked Potential (MEP) monitoring in a patient with Brugada syndrome.
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Use of therapeutic hypothermia and extracorporeal life support after an unusual response to the ajmaline challenge in a patient with Brugada syndrome
2014, Journal of Cardiology Cases
Citation Excerpt :
Brugada syndrome (BS) is a cardiac disorder, with electrocardiographic features of pseudo-right bundle-branch block and persistent ST-segment elevation in leads V1–V3 with high risk of sudden cardiac death [1,2].
Brugada syndrome is a cardiac disorder associated with a high risk of sudden cardiac death, especially in young subjects. The incidence and prevalence are likely underestimated. The diagnosis is based on a characteristic electrocardiography (ECG) pattern. The most commonly performed confirmatory test in cases of equivocal ECG is the intravenous ajmaline challenge. Although relatively safe, it carries the risk of ventricular arrhythmias that could potentially degenerate into a refractory electrical storm.
A 27-year-old man developed sustained ventricular fibrillation after ajmaline challenge. He was rescued on extracorporeal life support after 108 min of cardiopulmonary resuscitation. Extracorporeal life support allowed recovery of spontaneous circulation and resulted in a positive neurological outcome.
<Learning objective: This case is an example of how extracorporeal life support was instituted after prolonged and unsuccessful cardiopulmonary resuscitation resulting in a positive central neurological outcome.>
It took a Redbull to unmask Brugada syndrome
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Brugada-type electrocardiogram in the Taiwanese population-Is it a risk factor for sudden death?
2011, Journal of the Formosan Medical Association
People receive electrocardiogram (ECG) examination for various reasons in a hospital setting. An important clinical practice issue may be that cardiologists need to be consulted for Brugada-type ECGs identified through routine screening. We investigated the prevalence and prognosis of patients with Brugadatype ECG in a hospital-based population in an attempt to improve the management of these patients.
In 20,562 patients seeking medical care for non-cardiovascular reasons, 74,955 ECGs were performed from December 1999 to February 2001. The diagnostic criteria for Brugada-like ECG from the European Society of Cardiology were used. International Statistical Classification of Diseases codes and city residents' records were documented to indicate the reasons for visiting clinics or hospitalization and mortality outcome. Medical records were reviewed and telephone interviews were conducted.
Twenty-six (0.13%) of the 20,562 patients were confirmed to have Brugada-type ECGs. None of these patients had ever experienced syncope, near syncope or sudden cardiac death. After 57.1 ± 15.8 months of follow-up, there were four deaths out of the 26 patients with Brugada-type ECG (15.4%, 95% CI: 1.53-2.9%) compared with 2899 of those without (14.1%, 95% CI: 13.6-14.5%; p=0.89, log-rank test). Neither sudden cardiac death (p=0.61) nor hospitalized death (p=0.55) was different between patients with and without Brugada-type ECG.
Patients with Brugada-type ECGs are not rare in a hospital-based population. The presence of Brugada-type ECGs in patients without syncope or sudden cardiac death was not associated with hospitalized mortality.
Frequency of cardiac events at four years among initially asymptomatic Filipinos with the Brugada type 1 electrocardiographic pattern
2011, American Journal of Cardiology
Citation Excerpt :
All 7 subjects were men and were healthy and asymptomatic before initial diagnosis in 2003. The predominance of this condition in men is compatible with many reports in the literature.13 Two variant findings include occurrence of events during activity and sleep.
Brugada type 1 electrocardiographic (ECG) pattern occurs in 0.2% of Filipinos. A knowledge gap exists on the natural course of asymptomatic patients with Brugada type 1 ECG pattern. Most studies that reported cohort event rates were taken from hospitals or referral centers. This is the first cohort from an entire country where the subjects were selected randomly. The objective of this study was to describe the frequency of cardiac events at 4 and 6 years of 7 patients with Brugada type 1 ECG pattern of 3,907 patients previously screened from the general population of the Philippines during the National Nutrition and Health Survey. Personal interviews at year 4 using a structured questionnaire were conducted by 1 of the investigators. Occurrences of major (syncope, seizure, unexplained accidents, sudden death) and minor events in subjects and their first- and second-degree relatives were elicited. Six-year follow-up by text messaging was conducted to ascertain vital status and occurrence of cardiac events. All 7 patients with Brugada type 1 ECG pattern were men. Three of the 7 initially asymptomatic subjects (43%, 95 confidence interval 6 to 80) developed a major cardiac event by the fourth year. Those with events were younger than those without events. All 7 were alive by the sixth year. No additional events were noted between the fourth and sixth years. In conclusion, cardiac events are considerable in initially asymptomatic Filipinos with Brugada type 1 ECG pattern.

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¹: Dr. Atarashi's address is: The First Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113 Japan.

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Brief reportCharacteristics of patients with right bundle branch block and ST-segment elevation in right precordial leads

Abstract

J Am Coll Cardiol

J Am Coll Cardiol

Am Heart J

Am J Cardiol

Am J Cardiol

Am Heart J

Brief report
Characteristics of patients with right bundle branch block and ST-segment elevation in right precordial leads