Copyright © 2001 by the European Society of Cardiology.
New electrocardiographic leads and the procainamide test for the detection of the Brugada sign in sudden unexplained death syndrome survivors and their relatives
a Division of Cardiology, Chulalongkorn University, Bangkok, Thailand
b Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
c Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Received December 21, 2000; accepted March 6, 2001
Abstract
Aims Sudden unexplained death syndrome occurs in previously healthy South-east Asian young adults without any structural cause of death. The common electrocardiographic (ECG) change in sudden unexplained death syndrome survivors is right bundle branch block and ST elevations in leads V1to V3, which are similar to the ECG pattern in the Brugada syndrome (Brugada sign). It is difficult to diagnose the Brugada sign with the 12-lead ECG in sudden unexplained death syndrome survivors and their family members because the ECG could be transiently normalized. We proposed using the higher intercostal space V1to V3lead ECG, together with procainamide to detect the Brugada sign.
Methods and Results Among 20 ventricular fibrillation cardiac arrest patients, 13 sudden unexplained death syndrome survivors and their relatives (n=88) were studied using the single standard 12-lead ECG and the new six higher intercostal space V1to V3lead ECG (–V1to –V3and –2V1to –2V3). Ten sudden unexplained death syndrome survivors and relatives (n=48) who had a normalized ECG were also infused with procainamide (10mg.kg–1i.v.) to unmask the Brugada sign and both ECG methods were recorded. Forty healthy individuals and 13 spouses served as the control group. Prior to the procainamide infusion, the Brugada sign could be detected in nine sudden unexplained death syndrome survivors (69·2%) and three (3·4%) relatives with the standard ECG and in 12 (92·3%) and nine (10·2%) with the new six-lead ECG. After the procainamide infusion, the Brugada sign could be demonstrated in seven sudden unexplained death syndrome survivors (70%) and seven (14·6%) relatives with the standard ECG and in nine (90%) (P=0·26) and 23 (47·9%) (P=0·0004) with the new six-lead ECG, respectively. All the controls were negative for the Brugada sign.
Conclusions Our data suggest that the new higher intercostal space lead ECG, with or without the procainamide test is helpful in detecting the Brugada sign in sudden unexplained death syndrome survivors and their relatives.
Key Words: Sudden unexplained death syndrome, the Brugada syndrome, the Brugada sign, electrocardiographic leads, procainamide
f1 Correspondence: Somkiat Sangwatanaroj, MD, Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama 4 Road, Patumwan, Bangkok 10330, Thailand.
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