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(Circulation. 2001;103:710.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Right Bundle Branch Block, Right Precordial ST-Segment Elevation, and Sudden Death in Young People
From the Departments of Cardiology (D.C., G.B, A.N.) and Pathology (C.B., L.R., G.T.), University of Padua Medical School, Padua, Italy.
Correspondence to Gaetano Thiene, MD, Istituto di Anatomia Patologica, Via A. Gabelli, 61 - 35121 Padova, Italy. E-mail cardpath{at}ux1.unipd.it
Background—Patients with the ECG pattern of right bundle branch block and right precordial ST-segment elevation may experience sudden death in the setting of either arrhythmogenic right ventricular cardiomyopathy (ARVC) or a functional electrical disorder such as Brugada syndrome.
Methods and
Results—Among a series of 273 young (
35
years) victims of cardiovascular sudden death who were prospectively
studied from 1979 to 1998 in the Veneto Region of Italy, 12-lead ECG
was available in 96 cases. Thirteen (14%; 12 males and 1 female aged
24±8 years) had right precordial ST-segment elevation, either isolated
(9 cases) or associated with right bundle branch block (4 cases). At
autopsy, all patients had ARVC (92%) except one, who had no evidence
of structural heart disease. Compared with the 19 young sudden death
victims with ARVC and no ST-segment abnormalities from the same series,
those with AVRC and right precordial ST-segment elevation included
fewer competitive athletes (17% versus 58%;
P=0.03), more often died
suddenly at rest or during sleep (83% versus 26%;
P=0.003), and showed serial ECG
changes over time (83% versus 0;
P=0.015), polymorphic
ventricular tachycardia (33% versus 0;
P=0.016), and predominant fatty
replacement of the right ventricular anterior wall (58% versus 21%;
P=0.05),
Conclusions—Right precordial ST-segment elevation was found in 14% of young sudden death victims with available ECG. It mostly reflected underlying ARVC with predominant right ventricular anterior wall involvement and characterized a subgroup of patients who share with Brugada patients the propensity to die from non–exercise-related cardiac arrest and to exhibit dynamic ECG changes and polymorphic ventricular tachycardia.
Key Words: arrhythmogenic right ventricular dysplasia • fibrillation • death, sudden
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