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(Circulation. 1997;96:2595-2600.)
© 1997 American Heart Association, Inc.
Articles |
Arrhythmogenic Marker for the Sudden Unexplained Death Syndrome in Thai Men
From the Divisions of Cardiology, Department of Medicine, University of Southern California School of Medicine, Los Angeles (K.N.), and Bhumipol Adulyadej Hospital, Royal Thai Air Force (G.V.); and the Departments of Medicine, Faculty of Medicine, Siriraj Hospital and Mahidol University (S.N., K.B., P.M.), Ubolrajthani Provincial Hospital (V.C.), Ramathibode Hospital, Mahidol University (K.L.), Chulalongkorn University (K.T.), Songklanakarin University (S.K.), Central Chest Hospital (S.T.), and Khon Kaen University (P.T.), Thailand.
Background Between 1981 and 1988, the Centers for Disease Control and Prevention reported a very high incidence of sudden death among young male Southeast Asians who died unexpectedly during sleep. The pattern of death has long been prevalent in Southeast Asia. We carried out a study to identify the clinical markers for patients at high risk of developing sudden unexplained death syndrome (SUDS) and long-term outcomes.
Methods and Results We studied 27 Thai men (mean age,
39.7±11 years) referred because they had cardiac arrest due to
ventricular fibrillation, usually occurring at night while
asleep (n=17), or were suspected to have had symptoms similar to the
clinical presentation of SUDS (n=10). We performed cardiac
testing, including EPS and cardiac catheterization. The
patients were then followed at 
3-month intervals; our primary end
points were death, ventricular fibrillation, or cardiac
arrest. A distinct ECG abnormality divided our patients who had no
structural heart disease (except 3 patients with mild left
ventricular hypertrophy) into two groups: group
1 (n=16) patients had right bundle-branch block and ST-segment
elevation in V1 through V3, and group 2 (n=11)
had a normal ECG. Group 1 patients had well-defined
electrophysiological abnormalities: group 1
had an abnormally prolonged His-Purkinje conduction time (HV interval,
63±11 versus 49±6 ms; P=.007). Group 1 had a higher
incidence of inducible ventricular fibrillation (93% for
group 1 versus 11% for group 2; P=.0002) and a positive
signal-averaged ECG (92% for group 1 versus 11% for group 2;
P=.002), which was associated with a higher incidence of
ventricular fibrillation or death (P=.047). The
life-table analysis showed that the group 1 patients had a much
greater risk of dying suddenly (P=.05).
Conclusions Right bundle-branch block and precordial injury pattern in V1 through V3 is common in SUDS patients and represents an arrhythmogenic marker that identifies patients who face an inordinate risk of ventricular fibrillation or sudden death.
Key Words: Thailand • bundle-branch block • death, sudden • fibrillation • ventricle
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