BACKGROUND: The prevalence of the Brugada-type ECG and its natural history are still unclear. The recently proposed diagnostic criteria have not been systematically applied in a European general population. METHODS: We retrospectively analyzed ECGs and clinical data of 12,012 apparently healthy individuals who had undergone medical examination for occupational reasons. We sought follow-up information on the subjects with at least one ECG fulfilling the criteria for the Brugada pattern. RESULTS: A Brugada-type ECG was found in 23 subjects (0.19%; 95% confidence interval 0.12-0.27%) on the first ECG recorded in that subject. In a further 8 cases, the Brugada pattern was present in a subsequent ECG, so that it was present at some time in 31 subjects (0.26%, 95% confidence interval 0.18-0.37%), all male. Only 2 patients displayed the classical type 1 Brugada ECG pattern. In 29 patients (94%), clinical information was available subsequent to the first Brugada pattern ECG recorded. The mean follow-up was 10.1+/-5.5 years. A sudden death occurred in a 27-year-old man with Brugada type 2 ECG pattern. No sudden death or symptomatic ventricular arrhythmia occurred among the other 28 patients. The annual rate of sudden death associated with Brugada ECG pattern was 0.3% per patient-year of follow-up. CONCLUSION: The Brugada-type ECG pattern, as currently defined, is uncommon in a young healthy male European population and confers a moderately elevated risk of sudden death. Our findings underscore the need to study risk predictors in asymptomatic patients with a Brugada-type ECG.