Incidence and Clinical Significance of Brugada Syndrome Masked by Complete Right Bundle-Branch Block

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  • Wada Tadashi
    Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
  • Nagase Satoshi
    Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
  • Morita Hiroshi
    Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
  • Nakagawa Koji
    Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
  • Nishii Nobuhiro
    Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
  • Nakamura Kazufumi
    Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
  • Kohno Kunihisa
    Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
  • Ito Hiroshi
    Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
  • Kusano Kengo F.
    Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
  • Ohe Tohru
    Department of Cardiology, Sakakibara Heart Institute of Okayama

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Abstract

Background:Brugada syndrome (BrS)-type electrocardiogram (ECG) is concealed by complete right bundle-branch block (CRBBB) in some cases of BrS. Clinical significance of BrS masked by CRBBB is not well known.Methods and Results:We reviewed an ECG database of 326 BrS patients who had type 1 ECG with or without pilsicainide. “BrS masked by CRBBB” was defined on ECG as <2-mm elevation of the J point at the time of CRBBB in the right precordial leads, and BrS-type J-point elevation ≥2 mm at the time of normalized QRS complex on relieved CRBBB. We identified 25 BrS patients (7.7%) with persistent (n=12) or intermittent CRBBB (n=13). Relief of CRBBB by pacing was performed in patients with persistent CRBBB. The prevalence of BrS masked by CRBBB was 3.1% (10/326 patients). Three patients had type 1 ECG, and 7 patients had type 2 or 3 ECG on relief of CRBBB. Two of these 10 patients had lethal arrhythmic events during the follow-up period (mean, 86.4±57.2 months). There was no prognostic difference between BrS masked by CRBBB and other BrS.Conclusions:In a small BrS population, CRBBB can completely mask typical BrS-type ECG. BrS masked by CRBBB is associated with the same risk of fatal ventricular tachyarrhythmia as other BrS. (Circ J 2015; 79: 2568–2575)

Journal

  • Circulation Journal

    Circulation Journal 79 (12), 2568-2575, 2015

    The Japanese Circulation Society

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