Brugada Syndrome and Its ECG Features

Introduction

Brugada syndrome is a genetic disorder that affects the electrical activity of the heart and increases the risk of sudden cardiac death due to ventricular arrhythmias. It is often diagnosed with characteristic findings on an electrocardiogram (ECG).

ECG Patterns of Brugada Syndrome

There are three distinct ECG patterns associated with Brugada syndrome, with Type 1 being the most diagnostic:

1. Type 1 (Coved-Type ST Elevation)

  • ST elevation of ≥2 mm in leads V1-V2
  • Followed by a negative T wave
  • May appear spontaneously or after provocation by sodium channel blockers (e.g., ajmaline, flecainide)

2. Type 2 (Saddleback ST Elevation)

  • ST elevation ≥2 mm but with a “saddleback” appearance
  • Not as specific for Brugada syndrome

3. Type 3 (Mixed Features)

  • ST elevation <2 mm with either coved or saddleback morphology

Diagnosis and Management

  • ECG findings should always be correlated with symptoms (syncope, cardiac arrest) and family history.
  • Confirmatory tests: Sodium channel blocker challenge test, genetic testing (mutations in SCN5A gene in some cases), and electrophysiological studies.
  • Treatment: First-line treatment is the implantation of an implantable cardioverter-defibrillator (ICD) in high-risk patients.
  • Lifestyle modifications: Avoid fever, certain drugs, and excessive alcohol.

Conclusion

Brugada syndrome is an important cause of sudden cardiac death in young individuals. Early recognition of its ECG pattern can be life-saving. If you suspect Brugada syndrome, evaluation by a cardiologist specializing in electrophysiology is crucial.

Source recommendations

1. European Society of Cardiology Guidelines on Sudden Cardiac Death

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Ventricular-Arrhythmias-and-the-Prevention-of-Sudden-Cardiac-Death
  2. https://academic.oup.com/eurheartj/article/43/40/3997/6675633
  3. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000549
  4. https://pubmed.ncbi.nlm.nih.gov/29191938/
  5. https://www.sciencedirect.com/science/article/pii/S2405500X22010945

2. American Heart Association Guidelines on Arrhythmias

  1. https://www.heart.org/en/health-topics/arrhythmia
  2. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193
  3. https://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia
  4. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000549
  5. https://pubmed.ncbi.nlm.nih.gov/29084733/

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