Iranian Heart Journal

Iranian Heart Journal

Prevalence and Pattern of Brugada Syndrome: A Five-Year Cohort Registry of 4000 Patients

Document Type : Original Article

Authors
1 Non-Communicable Disease Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran.
2 Isfahan University of Medical Sciences, Isfahan, IR Iran.
3 Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran.
4 Department of Emergency Medicine, Crisis Management and Emergency Medical Services of Markazi Province, Arak University of Medical Sciences, Arak, IR Iran.
5 Department of Anatomy, School of Medicine, Fasa University of Medical Sciences, Fasa, IR Iran.
Abstract
Background: Patients with Brugada syndrome and a history of sudden cardiac death are at an increased risk for arrhythmias, necessitating the potential use of an implantable cardioverter defibrillator. Diagnostic procedures involve identifying a specific ECG pattern either spontaneously or during a sodium channel blocker test.
 
Methods: This cohort study examined patients’ records from 2015 through 2020 in Shiraz. A random sample of 4000 individuals was selected, and their clinical records were assessed. After registering participants’ baseline information, including age, sex, family history, and disease status, ECGs were taken to investigate Brugada syndrome. ECG findings were then reviewed by cardiologists.
 
Results: Among the 4000 participants, 16 had suspicious ECG findings or a family history of sudden death. Of these, 12 patients exhibited Brugada patterns (types 2 and 3), while 4 were diagnosed with Brugada syndrome (type 1). During the 5-year follow-up period, none of the patients experienced any adverse events. Patients diagnosed with Brugada syndrome were predominantly between 18 and 49 years old.
 
Conclusions: The prevalence of Brugada patterns and syndrome in Iran was found to be similar to the global average and lower than in Southeast Asia. Additionally, the syndrome’s prevalence was significantly higher in men than in women. The highest prevalence was observed in individuals aged 18 to 49 years, indicating a trend toward earlier disease manifestation. No echocardiographic findings specific to Brugada syndrome were identified in this study, and the patients had a favorable 5-year prognosis. (Iranian Heart Journal 2024; 25(4): 22-30)
Keywords

  1. Fabbris JL, Mesquita AC, Caldeira S, Carvalho AMP, Carvalho ECd. Anxiety and spiritual well-being in nursing students: A cross-sectional study. Journal of Holistic Nursing. 2017; 35(3):261-70.
  2. Vutthikraivit W, Rattanawong P, Putthapiban P, Sukhumthammarat W, Vathesatogkit P, Ngarmukos T, et al. Worldwide Prevalence of Brugada Syndrome: A Systematic Review and Meta-Analysis. Acta Cardiol Sin. 2018; 34(3):267-77.
  3. Brugada R, Campuzano O, Sarquella-Brugada G, Brugada P, Brugada J, Hong K. Brugada syndrome. GeneReviews®[Internet]. 2016.
  4. Wylie J, Garlitski A. Brugada syndrome: Clinical presentation, diagnosis, and evaluation. Uptodate; 2018.
  5. Patocskai B, Antzelevitch C. Novel therapeutic strategies for the management of ventricular arrhythmias associated with the Brugada syndrome. Expert opinion on orphan drugs. 2015; 3(6):633-51.
  6. Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac Death. The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology. Giornale italiano di cardiologia (2006). 2016; 17(2):108-70.
  7. Hedley PL, Jørgensen P, Schlamowitz S, Moolman‐Smook J, Kanters JK, Corfield VA, et al. The genetic basis of Brugada syndrome: a mutation update. Human mutation. 2009; 30(9):1256-66.
  8. MORADI MO, Sedaghat A, Niakan M, Hajiesmaeili M, Seifi S, Soleimanirad R. Sudden cardiac arrest due to Brugada syndrome: a case report and literature review. 2013.
  9. Quan X-Q, Li S, Liu R, Zheng K, Wu X-F, Tang Q. A meta-analytic review of prevalence for Brugada ECG patterns and the risk for death. Medicine. 2016; 95(50).
  10. Gourraud J-B BJ, Thollet A, Le Marec H, Probst V. . Brugada syndrome: diagnosis, risk stratification and management. Archives of cardiovascular diseases. 2017;110(3):188-95.
  11. Nishizaki M, Yamawake N, Sakurada H, Hiraoka M. ECG interpretation in Brugada syndrome. Journal of Arrhythmia. 2013; 29(2):56-64.
  12. Othieno AA, Isaacs DJ, Vinson DR, Levis JT. ECG Diagnosis: Brugada Syndrome. Perm J. 2019; 23.
  13. Conte G, Sieira J, Ciconte G, De Asmundis C, Chierchia G-B, Baltogiannis G, et al. Implantable cardioverter-defibrillator therapy in Brugada syndrome: a 20-year single-center experience. Journal of the American College of Cardiology. 2015; 65(9):879-88.
  14. Hermida J-S, Denjoy I, Clerc J, Extramiana F, Jarry G, Milliez P, et al. Hydroquinidine therapy in Brugada syndrome. Journal of the American College of Cardiology. 2004; 43(10):1853-60.
  15. Postema PG, Wolpert C, Amin AS, Probst V, Borggrefe M, Roden DM, et al. Drugs and Brugada syndrome patients: review of the literature, recommendations, and an up-to-date website (www. brugadadrugs. org). Heart Rhythm. 2009; 6(9):1335-41.
  16. Priori SG, Wilde AA, Horie M, Cho Y, Behr ER, Berul C, et al. HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes: document endorsed by HRS, EHRA, and APHRS in May 2013 and by ACCF, AHA, PACES, and AEPC in June 2013. Heart Rhythm. 2013; 10(12):1932-63.
  17. Patel SS, Anees S, Ferrick KJ. Prevalence of a Brugada pattern electrocardiogram in an urban population in the United States. Pacing Clin Electrophysiol. 2009; 32(6):704-8.
  18. Matsuo K AM, Nakashima E, Seto S, Yano K. . Clinical Characteristics of Subjects with the Brugada‐Type Electrocardiogram: A Case Control Study. Journal of cardiovascular electrophysiology. 2004; 15(6):653-7.
  19. Miyasaka Y TH, Yamada K, Tokunaga S, Saito D, Imuro Y, et al. Prevalence and mortality of the Brugada-type electrocardiogram in one city in Japan. Journal of the American College of Cardiology. 2001; 38(3):771-4.
  20. Kamakura S. Epidemiology of Brugada syndrome in Japan and rest of the world. Journal of Arrhythmia. 2013; 29(2):52-5.
  21. Scheirlynck E, Van Malderen S, Motoc A, Lie Ø H, de Asmundis C, Sieira J, et al. Speckle tracking echocardiography data in Brugada syndrome patients. Data Brief. 2019; 25:104330.
  22. Toh N, Morita H, Nagase S, Taniguchi M, Miura D, Nishii N, et al. Atrial electrophysiological and structural remodeling in high-risk patients with Brugada syndrome: assessment with electrophysiology and echocardiography. Heart Rhythm. 2010; 7(2):218-24.
  23. Sieira J, Ciconte G, Conte G, Chierchia G-B, de Asmundis C, Baltogiannis G, et al. Asymptomatic Brugada syndrome: clinical characterization and long-term prognosis. Circulation: Arrhythmia and Electrophysiology. 2015; 8(5):1144-50.
  24. Makimoto H, Kamakura S, Aihara N, Noda T, Nakajima I, Yokoyama T, et al. Clinical impact of the number of extrastimuli in programmed electrical stimulation in patients with Brugada type 1 electrocardiogram. Heart Rhythm. 2012; 9(2):242-8.