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      Telemedicine for detecting Brugada Syndrome in eastern Indonesia: A multi-center prospective observational study

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          Abstract

          Background

          The incidence of Brugada syndrome has been reported to occur mostly in Asian countries. However, key countries such as Indonesia, the largest-populated Southeast Asian country, have yet to report any existing data regarding the incidence of Brugada syndrome among its population. Detecting these patients has been challenging, especially in primary healthcare settings, which generally have limited resources. Telemedicine may represent an ideal solution for initial diagnosis to determine if a patient may have this condition.

          Methods

          We collected and analyzed numerous 12-lead electrocardiograms (ECG) of patients who visited various healthcare centers in Makassar for routine medical check-up between June 2017–April 2018. Electrocardiograms from these centers were sent to the Cardiac Center at Dr. Wahidin Sudirohusodo Hospital in Makassar via telemedicine.

          Results

          During the period, we successfully obtained 9558 ECGs. While none of the patients were initially suspected of Brugada Syndrome, we found 102 (1.07%) among them to have a Brugada ECG pattern (BrEP). BrEP was more commonly found in males compared to females (67.6% vs. 32.4% of the cases found). There were significant differences in the number of confirmed cases among the types of BrEP for male and female patients. The number of confirmed cases of BrEP in male and female patients were significantly different (p < 0.05), where the number of cases for male vs. female was 8 vs. 4 for type 1, 17 vs. 1 for type 2, and 44 vs. 28 for type 3.

          Conclusion

          Brugada syndrome is a disease that is at grave risk of being frequently underdiagnosed. Our study indicates that telemedicine can become an appropriate tool that can assist physicians in detecting suspected patients. Future efforts should also be directed at studying the possible use of telemedicine for detecting other similarly rare conditions.

          Highlights

          • Brugada syndrome is a rare and dangerous condition which is challenging to detect in developing countries with low resources.

          • GPs are heavily relied on to provide an early diagnosis for patients, including those suspected of Brugada syndrome.

          • Telemedicine allows a faster way for GPs to consult ECG images with cardiologists in order to provide an initial diagnosis.

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          Most cited references32

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          STROCSS 2019 Guideline: Strengthening the reporting of cohort studies in surgery

          The STROCSS guideline was developed in 2017 to improve the reporting quality of observational studies in surgery. Building on its impact and usefulness, we sought to update the guidelines two years after its publication.
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            Brugada syndrome: report of the second consensus conference: endorsed by the Heart Rhythm Society and the European Heart Rhythm Association.

            Since its introduction as a clinical entity in 1992, the Brugada syndrome has progressed from being a rare disease to one that is second only to automobile accidents as a cause of death among young adults in some countries. Electrocardiographically characterized by a distinct ST-segment elevation in the right precordial leads, the syndrome is associated with a high risk for sudden cardiac death in young and otherwise healthy adults, and less frequently in infants and children. Patients with a spontaneously appearing Brugada ECG have a high risk for sudden arrhythmic death secondary to ventricular tachycardia/fibrillation. The ECG manifestations of Brugada syndrome are often dynamic or concealed and may be unmasked or modulated by sodium channel blockers, a febrile state, vagotonic agents, alpha-adrenergic agonists, beta-adrenergic blockers, tricyclic or tetracyclic antidepressants, a combination of glucose and insulin, hypo- and hyperkalemia, hypercalcemia, and alcohol and cocaine toxicity. In recent years, an exponential rise in the number of reported cases and a striking proliferation of articles defining the clinical, genetic, cellular, ionic, and molecular aspects of the disease have occurred. The report of the first consensus conference, published in 2002, focused on diagnostic criteria. The present report, which emanated from the second consensus conference held in September 2003, elaborates further on the diagnostic criteria and examines risk stratification schemes and device and pharmacological approaches to therapy on the basis of the available clinical and basic science data.
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              Worldwide Prevalence of Brugada Syndrome: A Systematic Review and Meta-Analysis.

              Brugada syndrome (BrS) is considered to be an inherited arrhythmic disease associated with fatal complications and premature sudden unexpected death. The prevalence of the Brugada electrocardiogram pattern (BrP) has been reported in several countries. Nonetheless, the specific worldwide prevalence of BrS has not been reported.
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                Author and article information

                Contributors
                Journal
                Ann Med Surg (Lond)
                Ann Med Surg (Lond)
                Annals of Medicine and Surgery
                Elsevier
                2049-0801
                21 April 2021
                May 2021
                21 April 2021
                : 65
                : 102334
                Affiliations
                [a ]Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University/Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
                [b ]Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
                Author notes
                []Corresponding author. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, 90245, Makassar, Indonesia. muzakkir@ 123456unhas.ac.id
                Article
                S2049-0801(21)00284-3 102334
                10.1016/j.amsu.2021.102334
                8094895
                109b3af7-974a-4d0f-a660-6c0f73eab5c3
                © 2021 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 11 March 2021
                : 10 April 2021
                : 13 April 2021
                Categories
                Cohort Study

                telemedicine,brugada electrocardiogram pattern,brugada syndrome,southeast asia,prevalence

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