A spontaneous change in ST segment was associated with the highest risk for sudden death or ventricular tachyarrhythmia in subjects with a Brugada-type ECG (HR 9.2; P=0.036).
Cohort (n=124)
Do noninvasive risk indices predict sudden death or ventricular tachyarrhythmia in subjects with a Brugada-type ECG and no history of cardiac arrest?
A spontaneous change in ST segment, along with syncopal episodes, family history of sudden death, and late potentials, can help noninvasively risk-stratify patients with a Brugada-type ECG.
Effect estimate: HR 9.2
p-value: p=0.036
BACKGROUND: Recent studies suggest that the Brugada-type electrocardiogram (ECG) is much more prevalent than the manifest Brugada syndrome. Although invasive electrophysiologic investigations have been proposed as a risk stratifier, their value is controversial, and alternative noninvasive techniques may be preferred. We sought a noninvasive strategy to detect a high-risk group in a long-term follow-up study of subjects with a Brugada-type ECG, and no history of cardiac arrest. METHODS: This study enrolled 124 consecutive subjects with a Brugada-type ECG. Prognostic indices included: age, sex, a family history of sudden death, syncopal episodes, a spontaneous coved-type ST-segment elevation, maximal magnitude of ST-segment elevation, a spontaneous change in ST segment, a mean QRS duration, maximal QT interval, QT dispersion, late potentials (LP) by signal-averaged ECG, and microvolt T-wave alternans. RESULTS: Of the 124 subjects, 20 consenting subjects had an implantable defibrillator before follow-up. During a 40 +/- 19-month follow-up, 12 subjects (9.7%) reached one of the endpoints (sudden death or ventricular tachyarrhythmia). Of the 12 risk indices, a family history of sudden death, syncopal episodes, a spontaneous coved-type ST-segment elevation, a spontaneous change in ST segment, and LP had significant values. In multivariate analysis, a spontaneous change in ST segment had the most significance (a relative hazard, 9.2; P = 0.036). Combined assessment of this index and other significant indices obtained higher positive predictive values (43-71%). CONCLUSIONS: A spontaneous change in ST segment is associated with the highest risk for subsequent events in subjects with a Brugada-type ECG. The presence of syncopal episodes, a history of familial sudden death, and/or LP may increase its value.
Ikeda et al. (Sat,) conducted a cohort in Brugada-type electrocardiogram with no history of cardiac arrest (n=124). Spontaneous change in ST segment was evaluated on Sudden death or ventricular tachyarrhythmia (HR 9.2, p=0.036). A spontaneous change in ST segment was associated with the highest risk for sudden death or ventricular tachyarrhythmia in subjects with a Brugada-type ECG (HR 9.2; P=0.036).