Right bundle branch block, right precordial ST-segment elevation, and sudden death in young people

Background-Patients with the ECG pattern of right bundle branch block and r ight precordial ST-segment elevation may experience sudden death in the set ting 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 (less than or equal to 35 y ears) 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 r ight precordial ST-segment elevation, either isolated (9 cases) or associat ed with right bundle branch block (4 cases). At autopsy, all patients had A RVC (92%) except one, who had no evidence of structural heart disease. Comp ared with the 19 young sudden death victims with ARVC and no ST-segment abn ormalities from the same series, those with AVRC and right precordial ST-se gment elevation included fewer competitive athletes (17% versus 58%, P=0.03 ), more often died suddenly at rest or during sleep (83% versus 26%; P=0.00 3), and showed serial ECG changes over time (83% versus 0; P=0.015), polymo rphic ventricular tachycardia (33% versus 0; P=0.016), and predominant fatt y replacement of the right ventricular anterior wall (58% versus 21%; P=0.0 5). Conclusions-Right precordial ST-segment elevation was found in 14% of young sudden death victims with available EGG. It mostly reflected underlying AR VC with predominant right ventricular anterior wall involvement and charact erized a subgroup of patients who share with Brugada patients the propensit y to die from non-exercise-related cardiac arrest and to exhibit dynamic EC G changes and polymorphic ventricular tachycardia.