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Background  Brugada syndrome is recognized as being associated with sudden cardiac death; however, the prevalence of non–type 1 Brugada‐type  ECG  (BrS) or atypical  ST ‐segment elevation in the right precordial leads ( STERP ) and the long‐term prognosis for those patients remain unknown.    Methods and Results  We analyzed standard 12‐lead  ECG s of 7178 apparently healthy participants (age range 40–64 years) who underwent health checkups from 1982 to 1986 in the Circulatory Risk in Communities Study, a prospective, large, community‐based cohort study in Japan.  ECG s with J point amplitude ≥0.2 mV in the right precordial leads were divided into 3 groups: (1) type 1 BrS, (2) type 2 or 3 BrS (non‐type 1 BrS), and (3)  STERP . The others served as the non– ST ‐segment elevation group. We identified 8 participants (0.1%) with type1 BrS, 84 (1.2%) with non–type 1 BrS, and 228 (3.2%) with  STERP . During a median follow‐up of 18.7 years (133 987.0 person‐years), sudden cardiac death was observed in no participants (0.0%) with type 1 BrS, in 1 (1.2%) with non–type 1 BrS, in 7 (3.1%) with  STERP , and in 50 (0.7%) with non– ST ‐segment elevation. Participants with  STERP  had a markedly elevated risk of sudden cardiac death (multivariable hazard ratio 3.9, 95% CI 1.7–9.0).    Conclusions   STERP  was associated with an elevated risk of sudden cardiac death in a middle‐aged population.

journal of the american heart association

Long‐Term Prognosis of Brugada‐Type  ECG  and  ECG  With Atypical  ST ‐Segment Elevation in the Right Precordial Leads Over 20 Years: Results From the Circulatory Risk in Communities Study ( CIRCS )