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.
References
- Parrisk RG, Tucker M, Ing R, Encamacion C, Ebergardt M. Sudden unexplained death syndrome in Southeast Asian refugees: A review of CDC surveillance. MMWR CDC Surveil Summ. 1987;36:43SS–53SS
- Tatsanavivat P, Chirawatkul A, Klungboonkrong V. Sudden and unexplained deaths in sleep (Lai Tai) of young men in rural north-eastern Thailand. Int J Epidemiol. 1992;21:904–910
[Abstract/Free Full Text] - Brugada P, Brugada J. Right bundle-branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome. A multicenter report. J Am Coll Cardiol. 1992;20:1391–1396[Abstract]
- Nademanee K, Veerakul G, Nimmannit S. Arrhythmogenic marker for the sudden unexplained death syndrome in Thai men. Circulation. 1997;96:2595–2600
[Abstract/Free Full Text] - Bjerregaard P, Gussak I, Antzelevitch C. The enigmatic ECG manifestation of Brugada syndrome. J Cardiovasc Electrophysiol. 1998;9:109–111[Web of Science][Medline]
- Antzelevitch C, Nesterenko VV, Yan GX. Ionic processes underlying the action potential. Liebman J. Electrocardiology 1996: From the cell to the body surface. Singapore: World Scientific Publishing Co. Pte. Ltd; 1996. p. 219–229
- Michaelides AP, Psomadaki ZD, Dilaveris PE. Improved detection of coronary artery disease by exercise electrocardiography with the use of right precordial leads. N Engl J Med. 1999;340:340–345
[Abstract/Free Full Text] - Bezzina C, Veldkamp MW, van den Berg MP. A single Na+channel mutation causing both long QT and Brugada syndromes. Circ Res. 1999;85:1206–1213
[Abstract/Free Full Text] - Sangwatanaroj, S, Prechawat, S, Sunsaneewitayakul, B, The Right Ventricular Electrocardiographic Leads for Detection of Brugada Syndrome in Sudden Unexplained Death Syndrome Survivors and Their Relatives, Clin Cardiol
- Shimizu W, Matsuo K, Takagi M. Body surface distribution and response to drugs of ST segment elevation in Brugada syndrome: Clinical implication of eighty-seven-lead body surface potential mapping and its application to twelve-lead electrocardiograms. J Cardiovasc Electrophysiol. 2000;11:396–404[Web of Science][Medline]
- Chen Q, Kirsch GE, Zhang D. Genetic basis and molecular mechanism for idiopathic ventricular fibrillation. Nature. 1998;392:293–296[CrossRef][Medline]
- Brugada R, Brugada J, Antzelevitch C. Sodium channel blockers identify risk for sudden death in patients with ST-segment elevation and right bundle branch block but structurally normal hearts. Circulation. 2000;101:510–515
[Abstract/Free Full Text] - Brugada P, Brugada R, Brugada J. Sudden death in patients and relatives with the syndrome of right bundle branch block, ST segment elevation in the precordial leads V1to V3and sudden death. Eur Heart J. 2000;21:321–326
[Abstract/Free Full Text] - Falk RH. Flecainide-induced ventricular tachycardia and fibrillation in patients treated with atrial fibrillation. Ann Intern Med. 1989;111:107–111
[Abstract/Free Full Text] - Kasanuki H, Ohnishi S, Ohtuka M. Idiopathic ventricular fibrillation induced with vagal activity in patients without obvious heart disease. Circulation. 1997;95:2277–2285
[Abstract/Free Full Text] - Priori SG, Napolitano C, Gasparini M. Clinical and genetic heterogeneity of right bundle branch block and ST-segment elevation syndrome. Circulation. 2000;102:2509–2515
[Abstract/Free Full Text] - Hermida J, Lemoine J, Aoun FB, Jarry G, Rey J, Quiret J. Prevalence of the Brugada syndrome in an apparently healthy population. Am J Cardiol. 2000;86:91–94[CrossRef][Web of Science][Medline]
- Viskin S, Fish R, Eldar M. Prevalence of the Brugada sign in idiopathic ventricular fibrillation and healthy controls. Heart. 2000;84:31–36
[Abstract/Free Full Text] - Tohyou Y, Nakazawa K, Ozawa A. A survey in the incidence of right bundle branch block with ST elevation among normal population. Jpn J Electrocardiol. 1995;15:223–226
- Farre' J. The Brugada syndrome: do we need more than the 12-lead ECG? Eur Heart J. 2000;21:264–265
[Free Full Text] - Tarin N, Farre' J, Rubio JM, Tunon J, Castro-Dorticos J. Brugada-like electrocardiographic pattern in a patient with a mediastinal tumor. PACE. 1999;22:1264–1266
- Roden DM, Wilde AAM. Drug-induced J-point elevation: a marker for genetic risk of sudden death or ECG curiosity? J Cardiovasc Electrophysiol. 1999;10:219–223[Web of Science][Medline]
- Fujiki A, Usui M, Nagasawa H, Mizumaki K, Hayashi H, Inoue H. ST segment elevation in the right precordial leads induced with class 1C antiarrhythmic drugs: insight into the mechanism of Brugada syndrome. J Cardiovasc Electrophysiol. 1999;10:214–218[Web of Science][Medline]
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M. F. Sinner, A. Pfeufer, S. Perz, E. Schulze-Bahr, G. Monnig, L. Eckardt, B.-M. Beckmann, H.-E. Wichmann, G. Breithardt, G. Steinbeck, et al. Spontaneous Brugada electrocardiogram patterns are rare in the German general population: results from the KORA study Europace, October 1, 2009; 11(10): 1338 - 1344. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. P. Sidik, C. N. Quay, F. C. Loh, and L. Y. Chen Prevalence of Brugada sign and syndrome in patients presenting with arrhythmic symptoms at a Heart Rhythm Clinic in Singapore Europace, May 1, 2009; 11(5): 650 - 656. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Nagase, K. F. Kusano, H. Morita, N. Nishii, K. Banba, A. Watanabe, S. Hiramatsu, K. Nakamura, S. Sakuragi, and T. Ohe Longer Repolarization in the Epicardium at the Right Ventricular Outflow Tract Causes Type 1 Electrocardiogram in Patients With Brugada Syndrome J. Am. Coll. Cardiol., March 25, 2008; 51(12): 1154 - 1161. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. K. Riezebos, K. de Man, M. S. Patterson, and G. S. de Ruiter A bridge to Brugada Europace, June 1, 2007; 9(6): 398 - 400. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Teijeiro, H. A. Garro, R. S. Acunzo, E. Albino, and P. A. Chiale Recording of High V1-V3 Precordial Leads May Be Essential to the Diagnosis of Brugada Syndrome During the Ajmaline Test Journal of Cardiovascular Pharmacology and Therapeutics, June 1, 2006; 11(2): 153 - 155. [Abstract] [PDF]
|
|
|
|
 |
|
 P. G. Meregalli, A. A.M. Wilde, and H. L. Tan Pathophysiological mechanisms of Brugada syndrome: Depolarization disorder, repolarization disorder, or more? Cardiovasc Res, August 15, 2005; 67(3): 367 - 378. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Antzelevitch, P. Brugada, M. Borggrefe, J. Brugada, R. Brugada, D. Corrado, I. Gussak, H. LeMarec, K. Nademanee, A. R. Perez Riera, et al. Brugada Syndrome: Report of the Second Consensus Conference: Endorsed by the Heart Rhythm Society and the European Heart Rhythm Association Circulation, February 8, 2005; 111(5): 659 - 670. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-S. Hermida, I. Denjoy, G.èv. Jarry, S. Jandaud, C. Bertrand, and J. Delonca Electrocardiographic predictors of Brugada type response during Na channel blockade challenge Europace, January 1, 2005; 7(5): 447 - 453. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Morita, S. T. Morita, S. Nagase, K. Banba, N. Nishii, Y. Tani, A. Watanabe, K. Nakamura, K. F. Kusano, T. Emori, et al. Ventricular arrhythmia induced by sodium channel blocker in patients with Brugada syndrome J. Am. Coll. Cardiol., November 5, 2003; 42(9): 1624 - 1631. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Brugada, J. Brugada, and R. Brugada Dealing with biological variation in the Brugada syndrome Eur. Heart J., December 2, 2001; 22(24): 2231 - 2232. [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||