Relatively Benign Clinical Course in Asymptomatic Patients with Brugada‐Type Electrocardiogram Without Family History of Sudden Death

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Abstract
Asymptomatic Brugada‐Type ECG. Introduction: The incidence of sudden death or ventricular fibrillation (VF) in asymptomatic Brugada syndrome patients with a family history of sudden death is reported to be very high. However, there are few reports on the prognosis of asymptomatic Brugada syndrome patients without a family history of sudden death. Methods and Results: Eleven patients (all male; mean age 40.5 ± 9.6 years, range 26 to 56) with asymptomatic Brugada‐type ECG who had no family history of sudden death were evaluated. The degrees of ST segment elevation and conduction delay on signal‐averaged ECG (SAECG) before and after pilsicainide were evaluated in all 11 patients. VF inducibility by ventricular electrical stimulation also was evaluated in 8 of 11 patients. Patients were followed for a period of 9 to 84 months (mean 42.5 ± 21.6). The J point level was increased (V1 :0.19 ± 0.09 mV to 0.36 ± 0.23 mV; V2: 0.31 ± 0.12 mV to 0.67 ± 0.35 mV) by pilsicainide. Conduction delay was increased (total QRS: 112.2 ± 6.3 msec to 131 7 ± 6.3 msec; under 40 μ V: 42.0 ± 8.5 msec to 52.7 ± 12.7 msec; last 40 msec: 17.4 ± 5.9 μ V to 10.4 ± 6.1 μ V) on SAECG by pilsicainide. VF was induced in only 1 of 8 patients. None of the patients had syncope or sudden death during a mean follow‐up of 42.5 ± 21.6 months. Conclusion: This study suggests that asymptomatic patients with Brugada‐type ECG who have no family history of sudden death have a relatively benign clinical course.

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