[Prevalence of Brugada syndrome among 35,309 inhabitants of Lorraine screened at a preventive medicine centre]. / Prevalence du syndrome de Brugada dans une population de médecine préventive en Lorraine a propos de 35,309 cas.

UNLABELLED: Brugada syndrome is a recently identified cause of sudden death. Its primary prevention remains controversial, and epidemiology poorly defined. PATIENT POPULATION AND METHODS: Electrocardiograms (ECG) of 35,309 individuals (mean age = 37.2 years, 47% men) recorded over a 1-year period were reviewed and classified as (1) typical, (2) suspicious, and (3) negative. Subjects whose ECG was suspicious were offered a provocative test with flecainide, 2 mg/kg, i.v., and individuals whose ECG was typical were advised to undergo programmed ventricular stimulation (PVS). RESULTS: In 14 men and 6 women between the ages of 24 and 77 years (mean =47.5), ECGs were typical (n=6) or suspicious (n=14). Among 6 subjects with typical ECGs, 3 underwent PVS, which was positive in 1, who received an implantable cardioverter defibrillator (ICD). Among 14 subjects whose ECGs were suspicious, 5 declined further investigations and 5 developed typical ECG characteristics of Brugada syndrome after flecainide administration. PVS was negative in 4 subjects who consented to the procedure. Overall, among 35,309 individuals screened, 11 had ECG findings consistent with Brugada syndrome and, over a follow-up of 30 months, all had remained free of adverse cardiac event. CONCLUSIONS: we estimated a prevalence of Brugada syndrome of 0.3% in Lorraine. A single patient received an ICD for inducible ventricular tachyarrhythmia during PVS, representing a potential 30 per million asymptomatic adult rate of ICD implantation for this indication.

[Sudden death during Holter recording. Possible iatrogenic role of cardiovascular drugs. 10 cases]. / Morts subites au cours d'un enregistrement Holter. Rôle iatrogène possible des médicaments cardio-vasculaires. Dix observations.

Ten patients who presented with advanced heart disease and severe ventricular arrhythmia could be considered "at high risk of sudden death" caused by ventricular fibrillation. Yet they died suddenly while under Holter monitoring, and the recordings demonstrated that 4 of these deaths were due to a major disorder of conduction and 6 to ventricular fibrillation. Further analysis of these cases showed that the lethal disturbance of heart rhythm was ascribable to an anti-arrhythmic drug in 5 cases (2 with conduction disorder, 3 with ventricular fibrillation). It would appear that although patients of this kind need anti-arrhythmic drugs, these should be given with caution and in lower doses than in patients with normal left ventricular function.