Ethnic differences in patients with Brugada syndrome and arrhythmic events: New insights from Survey on Arrhythmic Events in Brugada Syndrome


      There is limited information on ethnic differences between patients with Brugada syndrome (BrS) and arrhythmic events (AEs).


      The purpose of this study was to compare clinical, electrocardiographic (ECG), electrophysiological, and genetic characteristics between white and Asian patients with BrS and AEs.


      The Survey on Arrhythmic Events in Brugada Syndrome is a multicenter survey from Western and Asian countries, gathering 678 patients with BrS and first documented AE. After excluding patients with other (n = 14 [2.1%]) or unknown (n = 30 [4.4%]) ethnicity, 364 (53.7%) whites and 270 (39.8%) Asians comprised the study group.


      There was no difference in AE age onset (41.3 ± 16.1 years in whites vs 43.3 ± 12.3 years in Asians; P = .285). Higher proportions of whites were observed in pediatric and elderly populations. Asians were predominantly men (98.1% vs 85.7% in whites; P < .001) and frequently presented with aborted cardiac arrest (71.1% vs 56%; P < .001). Asians tended to display more spontaneous type 1 BrS-ECG pattern (71.5% vs 64.3%; P = .068). A family history of sudden cardiac death was noted more in whites (29.1% vs 11.5%; P < .001), with a higher rate of SCN5A mutation carriers (40.1% vs 13.2% in Asians; P < .001), as well as more fever-related AEs (8.5% vs 2.9%; P = .011). No difference was observed between the 2 groups regarding history of syncope and ventricular arrhythmia inducibility.


      There are important differences between Asian and white patients with BrS. Asian patients present almost exclusively as male adults, more often with aborted cardiac arrest and spontaneous type 1 BrS-ECG. However, they have less family history of sudden cardiac death and markedly lower SCN5A mutation rates. The striking difference in SCN5A mutation rates should be tested in future studies.


      To read this article in full you will need to make a payment


      Subscribe to Heart Rhythm
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Milman A.
        • Andorin A.
        • Gourraud J.B.
        • et al.
        Age of first arrhythmic event in Brugada syndrome: data from the SABRUS (Survey on Arrhythmic Events in Brugada Syndrome) in 678 patients.
        Circ Arrhythm Electrophysiol. 2017; 10
        • Brugada P.
        • Brugada J.
        Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome. A multicenter report.
        J Am Coll Cardiol. 1992; 20: 1391-1396
        • Martini B.
        • Nava A.
        • Thiene G.
        • et al.
        Ventricular fibrillation without apparent heart disease: description of six cases.
        Am Heart J. 1989; 118: 1203-1209
        • Guazon M.
        Algunas notas sobre bangungut.
        Revista Filipina Med Y Farm. 1917; 8: 437-442
        • Aponte G.E.
        The enigma of “bangungut.
        Ann Int Med. 1960; 52: 1258-1263
        • Aihara N.
        • Matsuihisa M.
        • Kamakura S.
        • Kurita T.
        • Takaki H.
        • Shimomura K.
        Clinical and electrophysiologic characteristics of idiopathic ventricular fibrillation.
        Shinzo. 1990; 22: 80-86
        • Motoki K.
        • Tsujimura T.
        A case recovered from Pokkuri.
        Shinzo. 1990; 22: 1221-1226
        • Nademanee K.
        • Veerakul G.
        • Nimmannit S.
        • et al.
        Arrhythmogenic marker for the sudden unexplained death syndrome in Thai men.
        Circulation. 1997; 96: 2595-2600
        • Sangwatanaroj S.
        • Prechawat S.
        • Sunsaneewitayakul B.
        • Sitthisook S.
        • Tosukhowong P.
        • Tungsanga K.
        New electrocardiographic leads and the procainamide test for the detection of the Brugada sign in sudden unexplained death syndrome survivors and their relatives.
        Eur Heart J. 2001; 22: 2290-2296
        • Zheng J.
        • Zheng D.
        • Su T.
        • Cheng J.
        Sudden unexplained nocturnal death syndrome: the hundred years’ enigma.
        J Am Heart Assoc. 2018; 7
        • Baron R.C.
        • Thacker S.B.
        • Gorelkin L.
        • Vernon A.A.
        • Taylor W.R.
        • Choi K.
        Sudden death among Southeast Asian refugees: an unexplained nocturnal phenomenon.
        JAMA. 1983; 250: 2947-2951
        • Vutthikraivit W.
        • Rattanawong P.
        • Putthapiban P.
        • et al.
        Worldwide prevalence of Brugada syndrome: a systematic review and meta-analysis.
        Acta Cardiol Sin. 2018; 34: 267-277
        • Milman A.
        • Gourraud J.B.
        • Andorin A.
        • et al.
        Gender differences in patients with Brugada syndrome and arrhythmic events: data from a survey on arrhythmic events in 678 patients.
        Heart Rhythm. 2018; 15: 1457-1465
        • Milman A.
        • Andorin A.
        • Gourraud J.B.
        • et al.
        Profile of patients with Brugada syndrome presenting with their first documented arrhythmic event: data from the Survey on Arrhythmic Events in BRUgada Syndrome (SABRUS).
        Heart Rhythm. 2018; 15: 716-724
        • Priori S.G.
        • Blomstrom-Lundqvist C.
        • Mazzanti A.
        • et al.
        2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death.
        Eur Heart J. 2015; 36: 2793-2867
        • Huang L.
        • Wu K.H.
        • Zhang L.
        • et al.
        Critical roles of Xirp proteins in cardiac conduction and their rare variants identified in sudden unexplained nocturnal death syndrome and Brugada syndrome in Chinese Han population.
        J Am Heart Assoc. 2018; 7
        • Antzelevitch C.
        • Brugada P.
        • Borggrefe M.
        • et al.
        Brugada syndrome: report of the second consensus conference: endorsed by the Heart Rhythm Society and the European Heart Rhythm Association.
        Circulation. 2005; 111: 659-670
        • Murakoshi N.
        • Aonuma K.
        Epidemiology of arrhythmias and sudden cardiac death in Asia.
        Circ J. 2013; 77: 2419-2431
        • Bezzina C.R.
        • Shimizu W.
        • Yang P.
        • et al.
        Common sodium channel promoter haplotype in Asian subjects underlies variability in cardiac conduction.
        Circulation. 2006; 113: 338-344
        • Aizawa Y.
        • Fujisawa T.
        • Katsumata Y.
        • et al.
        Sex-dependent phenotypic variability of an SCN5A mutation: Brugada syndrome and sick sinus syndrome.
        J Am Heart Assoc. 2018; 7: e009387
        • Postema P.G.
        • van Dessel P.F.
        • Kors J.A.
        • et al.
        Local depolarization abnormalities are the dominant pathophysiologic mechanism for type 1 electrocardiogram in Brugada syndrome a study of electrocardiograms, vectorcardiograms, and body surface potential maps during ajmaline provocation.
        J Am Coll Cardiol. 2010; 55: 789-797
        • Michowitz Y.
        • Milman A.
        • Sarquella-Brugada G.
        • et al.
        Fever-related arrhythmic events in the multicenter Survey on Arrhythmic Events in Brugada Syndrome.
        Heart Rhythm. 2018; 15: 1394-1401
        • Shi S.
        • Barajas-Martinez H.
        • Liu T.
        • et al.
        Prevalence of spontaneous Brugada ECG pattern recorded at standard intercostal leads: a meta-analysis.
        Int J Cardiol. 2018; 254: 151-156
        • Kamakura S.
        • Ohe T.
        • Nakazawa K.
        • et al.
        Long-term prognosis of probands with Brugada-pattern ST-elevation in leads V1-V3.
        Circ Arrhythm Electrophysiol. 2009; 2: 495-503
        • Probst V.
        • Veltmann C.
        • Eckardt L.
        • et al.
        Long-term prognosis of patients diagnosed with Brugada syndrome: results from the FINGER Brugada Syndrome Registry.
        Circulation. 2010; 121: 635-643
        • Makarawate P.
        • Chaosuwannakit N.
        • Vannaprasaht S.
        • Tassaneeyakul W.
        • Sawanyawisuth K.
        Clinical characteristics and treatment outcomes of patients with Brugada syndrome in northeastern Thailand.
        Singapore Med J. 2014; 55: 217-220
        • Conte G.
        • Sieira J.
        • Ciconte G.
        • et al.
        Implantable cardioverter-defibrillator therapy in Brugada syndrome: a 20-year single-center experience.
        J Am Coll Cardiol. 2015; 65: 879-888
        • Hernandez-Ojeda J.
        • Arbelo E.
        • Borras R.
        • et al.
        Patients with Brugada syndrome and implanted cardioverter-defibrillators: long-term follow-up.
        J Am Coll Cardiol. 2017; 70: 1991-2002
        • Yamagata K.
        • Horie M.
        • Aiba T.
        • et al.
        Genotype-phenotype correlation of SCN5A mutation for the clinical and electrocardiographic characteristics of probands with Brugada syndrome: a Japanese multicenter registry.
        Circulation. 2017; 135: 2255-2270
        • Juang J.M.
        • Tsai C.T.
        • Lin L.Y.
        • et al.
        Unique clinical characteristics and SCN5A mutations in patients with Brugada syndrome in Taiwan.
        J Formos Med Assoc. 2015; 114: 620-626
        • Makarawate P.
        • Chaosuwannakit N.
        • Vannaprasaht S.
        • et al.
        SCN5A genetic polymorphisms associated with increased defibrillator shocks in Brugada syndrome.
        J Am Heart Assoc. 2017; 6
        • Juang J.J.
        • Horie M.
        Genetics of Brugada syndrome.
        J Arrhythm. 2016; 32: 418-425