Brugada syndrome in China: high prevalence and hidden risk of arrhythmias and sudden death in hospitalized patients

Brugada syndrome (BrS) is an inherited arrhythmic disorder characterized by ST-segment elevation (STE) on leads V1-V3 of electrocardiograms (ECG), and associated with an increased risk of sudden cardiac death (SCD). Although a high prevalence has been reported in some Southeast Asian countries, systematic epidemiological data from mainland China are currently lacking. This retrospective cross-sectional study enrolled 117,050 hospitalized patients at a tertiary hospital in Southern China between 2023 and 2024. Standard 12-lead electrocardiograms (ECG) were recorded from participants. Suspected BrS cases received either pharmacological challenge with propafenone or had right precordial leads placed in high intercostal spaces, followed by ambulatory ECG monitoring. BrS diagnosis was confirmed according to the 2013 h/EHRA/APHRS expert consensus criteria. A total of 244 BrS cases were confirmed, yielding a prevalence of 208.5 per 100,000 persons (95% CI: 184.2–234.8). Diagnosed BrS patients were predominantly males (84.8%), and the highest incidence was observed in the 20–40 age group (63.9%) and in non-cardiac wards (86.1%). Among 244 patients, 25.4% cases (64/244) presented with the type 1 BrS pattern (28.1% spontaneous, 67.2% fever-induced, and 4.7% propafenone-induced). Type 2 and 3 BrS patterns accounted for 26.2% and 48.4%, respectively. 29.5% of cases were symptomatic (syncope-25.0%, palpitations-23.6%, dizziness-33.3%), and 18.1% had a family history of SCD. During a median follow-up of 12 months, 1.6% of patients experienced SCD, and 23.8%, 13.1%, and 7.8% had ventricular tachycardia (VT), ventricular fibrillation (VF), and cardiac conduction disease, respectively. The symptomatic group showed significantly increased ratios of type 1 BrS patterns and family history of SCD compared with the asymptomatic group. Compared with the non-VF group (212 cases), the VF group (32 cases) showed significantly increased ratios of type 1 BrS patterns, symptoms, and a family history of SCD. This study reveals a high prevalence of BrS in the hospitalized population in Southern China. The findings highlight a substantial number of concealed BrS patients in this region and underscore the importance of systematic ECG screening and provocative testing in high-risk areas and populations for diagnosing potential BrS.