PREVALENCE OF BRUGADA SYNDROME IN A MULTI-ETHNIC SINGAPOREAN YOUNG MALE COHORT

To investigate the prevalence of BrS in an asymptomatic young male population in a large multi-ethnic Southeast Asian cohort.

All Singaporean men undergo pre-conscription medical screening prior to enlistment for compulsory military service, where demographic, anthropometric and electrocardiogram (ECG) variables were collected prospectively from January 2015 – December 2016. All individuals with ECG suspicious of Brugada pattern (any type), as well as those with a known family history of Brugada Syndrome (BrS) or sudden cardiac death (SCD) were referred to a tertiary centre for clinical evaluation by certified cardiac electro-physiologists, underwent structural evaluation with a transthoracic echocardiogram and were offered Flecainide study if indicated. Subsequently, all patients diagnosed with Brugada Syndrome were followed up over a 2-year period for outcomes including sudden cardiac death and malignant tachyarrhythmias. 

54,599 consecutive males (mean age 18.7±1.6 years) underwent medical screening. 840 individuals were referred for further evaluation. 287 had confirmed Brugada pattern ECG (any type) after electrophysiologist review. Spontaneous Type 1 Brugada ECG was present in 3 individuals. The other 284 had ECG features consistent with Type 2 or 3 Brugada pattern and were offered flecainide challenge testing. 214 subjects underwent flecainide testing. Of these, 53 (25%) tested positive for BrS. 56 individuals had a final diagnosis of BrS, yielding a prevalence of 0.10% in our large unselected young male population. Over 2 years’ follow-up, there were no tachyarrhythmia or SCD reported. No patient was lost to follow-up.

In a young, multi-ethnic South-east Asian male population, we found the prevalence of Brugada syndrome to be 0.10%. 2-year follow-up revealed no clinical events. Long-term follow-up studies will be needed to characterize the clinical significance and prognosis of individuals with BrS.