Long-Term Prognosis of Brugada-Type ECG and ECG With Atypical ST-Segment Elevation in the Right Precordial Leads Over 20 Years: Results From the Circulatory Risk in Communities Study (CIRCS)

Background-Brugada syndrome is recognized as being associated with sudden cardiac death; however, the prevalence of nontype 1 Brugada-type ECG (BrS) or atypical ST-segment elevation in the right precordial leads (STERP) and the long-term prognosis for those patients remain unknown. Methods and Results-We analyzed standard 12-lead ECGs of 7178 apparently healthy participants (age range 40-64 years) who underwent health checkups from 1982 to 1986 in the Circulatory Risk in Communities Study, a prospective, large, community-based cohort study in Japan. ECGs with J point amplitude >= 0.2 mV in the right precordial leads were divided into 3 groups: (1) type 1 BrS, (2) type 2 or 3 BrS (non-type 1 BrS), and (3) STERP. The others served as the non-ST-segment elevation group. We identified 8 participants (0.1%) with type 1 BrS, 84 (1.2%) with non-type 1 BrS, and 228 (3.2%) with STERP. During a median follow-up of 18.7 years (133 987.0 person-years), sudden cardiac death was observed in no participants (0.0%) with type 1 BrS, in 1 (1.2%) with non-type 1 BrS, in 7 (3.1%) with STERP, and in 50 (0.7%) with non-ST-segment elevation. Participants with STERP had a markedly elevated risk of sudden cardiac death (multivariable hazard ratio 3.9, 95% CI 1.7-9.0). Conclusions-STERP was associated with an elevated risk of sudden cardiac death in a middle-aged population.