Heart 2001;86:161-166 ( August )

Cardiovascular medicine

Prevalence of asymptomatic ST segment elevation in right precordial leads with right bundle branch block (Brugada-type ST shift) among the general Japanese population M Furuhashi^a, K Uno^a, K Tsuchihashi^a, D Nagahara^a, M Hyakukoku^a, T Ohtomo^b, S Satoh^b, T Nishimiya^b, K Shimamoto^a

^a Second Department of Internal Medicine, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo 060-0061, Japan, ^b Division of Cardiology, Asahikawa Red Cross Hospital, 1-1 Akebono Asahikawa, Hokkaido 070-8530, Japan

Correspondence to: Dr Furuhashi furuhasi{at}sapmed.ac.jp Accepted 23 January 2001

OBJECTIVETo examine the modality and morbidity of asymptomatic ST segment elevation in leads V1 to V3 with right bundle branch block (Brugada-type ST shift).
METHODS8612 Japanese subjects (5987 men and 2625 women, mean age 49.2 years) who underwent a health check up in 1997 were investigated. Those with Brugada-type ST shift underwent the following further examinations over a two year period after the initial check up: ECG, echocardiogram, 24 hour Holter monitoring, treadmill exercise testing, signal averaged ECG, and slow kinetic sodium channel blocker loading test (cibenzoline, 1.4 mg/kg).
RESULTSAsymptomatic Brugada-type ST shift was found in 12 of 8612 (0.14%) subjects. Eleven of these 12 subjects were followed up. Follow up ECG exhibited persistent Brugada-type ST shift in seven of 11 (63.6%) subjects. ST shift was transformed from a saddle back to a coved type in three subjects. None of the subjects had morphological abnormalities or abnormal tachyarrhythmias. Positive late potentials were found in seven of 11 (63.6%) subjects. Augmentation of ST shift was shown by both submaximal exercise and drug administration in one of the 11 subjects (9.1%).
CONCLUSIONSAsymptomatic subjects with Brugada-type ST shift were not unusual, at a rate of 0.14% in the general Japanese population. Almost all of the subjects had some abnormalities in non-invasive secondary examinations. Additional and prospective studies are needed to confirm the clinical significance and the prognosis of asymptomatic Brugada-type ST shift.


Keywords: Brugada syndrome; signal averaged electrocardiogram; sodium channel blocker; sudden death

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© 2001 by Heart
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