Greer Robert W, Glancy D Luke
Cardiology Fellowship Training Program, Louisiana State University Health Sciences Center, New Orleans, USA.
J La State Med Soc. 2003 Sep-Oct;155(5):242-6.
Since 1992 the Brugada syndrome has gained recognition as a cause of ventricular fibrillation. The syndrome was originally described in patients with the diagnostic triad of (1) right bundle branch block, (2) an electrocardiogram (ECG) with persistent ST-segment elevation in leads V1, V2, and V3, and (3) sudden cardiac death. Two different types of ST-segment elevation, coved and saddleback, have been described. All patients originally described had structurally normal hearts. The definition of the Brugada electrocardiogram (originally right bundle branch block and ST-segment elevation in V1, V2, and V3 in characteristic coved or saddleback configuration) has been evolving since the initial description, and not all patients with the Brugada electrocardiogram have the Brugada syndrome. We designed a trial to determine the prevalence in our population at the Medical Center of Louisiana in New Orleans of the Brugada ECG as it was originally defined. ECGs performed in 1997 were examined for changes consistent with the Brugada electrocardiogram. Those ECGs with changes secondary to another identifiable cause were excluded. The amount and type of ST-segment elevation in leads V1, V2, and V3 were recorded for the remaining ECGs. From a total of 55,446 electrocardiograms performed on 27,328 patients, we were able to identify only 18 ECGs with the changes originally described by Brugada, and none of them meet current criteria. Our study suggests that in our patient population the ECG now considered typical of the Brugada syndrome is rare.
自1992年以来， Brugada综合征已被确认为室颤的一个病因。该综合征最初在具有以下三联征的患者中被描述：（1）右束支传导阻滞；（2）心电图（ECG）在V1、V2和V3导联持续出现ST段抬高；（3）心源性猝死。已描述了两种不同类型的ST段抬高，即穹窿型和鞍背型。最初描述的所有患者心脏结构均正常。自最初描述以来，Brugada心电图（最初为右束支传导阻滞以及V1、V2和V3导联特征性的穹窿型或鞍背型ST段抬高）的定义一直在演变，并非所有具有Brugada心电图表现的患者都患有Brugada综合征。我们设计了一项试验，以确定在新奥尔良路易斯安那医疗中心我们的人群中最初定义的Brugada心电图的患病率。对1997年进行的心电图检查是否存在与Brugada心电图一致的变化。排除那些继发于另一个可识别原因的心电图变化。记录其余心电图V1、V2和V3导联ST段抬高的程度和类型。在对27328例患者进行的总共55446份心电图中，我们仅识别出18份具有Brugada最初描述变化的心电图，且没有一份符合当前标准。我们的研究表明，在我们的患者群体中，目前被认为是Brugada综合征典型表现的心电图很罕见。
