10th May 2025

Brugada syndrome

Brugada syndrome is characterized by right bundle branch block (RBBB) and ST-segment elevation in the anterior precordial leads of ECG, often without evidence of structural heart disease

Classification

• Type 1: Coved ST segment elevation
• Type 2: Saddleback ST elevation ≥ 1 mm
• Type 3: Saddleback ST elevation < 1mm

Image Source: Wikimedia Commons (2008). Brugada ECG, Licensed under a creative commons licence. Available for free at: https://commons.wikimedia.org/w/index.php?search=brugada+ecg&title=Special:MediaSearch&go=Go&type=image (Accessed 7 May 2025).

Diagnosis

Diagnostic criteria

• Type 1 ECG pattern occurring spontaneously
• Type 1 ECG provoked by class I anti-arrhythmic drugs with one additional clinical feature: documented ventricular tachycardia (VT) or ventricular fibrillation (VF), syncope of probable arrhythmic cause, family history of sudden cardiac death (SCD) before age 45, family history of brugada type 1 or nocturnal agonal respiration.

Clinical features

• Asymptomatic
• Syncope
• Aborted cardiac arrest due to VT/VF

Management

• Fever should be aggressively treated (can precipitate VT/VF)
• Avoid drugs that provoke Brugada syndrome (e.g. flecainide)
• ICD is indicated in patients with aborted SCD or spontaneous VT/VF or with a history of syncope
• Ablation may be considered in patients with frequent ICD shocks
• Quinidine may be considered in patients with frequent ICD shocks or who refuse ICD or in whom ICD is contraindicated