Quick Review: Brugada Syndrome

The Brugada syndrome is a genetic disease causing sudden cardiac death, first noticed among young Asian men by two Spanish cardiologists, the Brugada brothers.  It can be initially indicated by abnormal electrocardiogram (ECG) findings and results in an increased risk of sudden cardiac death.  It is inherited in an autosomal dominant fashion, and is found in all races and both genders, but is more prevalant in Asian populations.

The syndrome can result in syncope, cardiac arrest, or sudden cardiac death.  The typical patient is a young male, otherwise healthy.

The ECG pattern consists of persistent ST elevations in V1 to V3 leads with a right bundle branch block (RBBB) with or without terminal S waves in the lateral leads.

There are three types of ECG patterns:

• Type 1 has a coved type ST elevation with at least 2 mm J-point elevation and gradually descending ST segment, and a negative T-wave.
• Type 2 has a saddle back ST elevation with at least 2 mm J-point elevation and at least 1 mm ST elevation, with positive or biphasic T-wave.
• Type 3 has a saddle back ST elevation with less than 2 mm J-point elevation and less than 1 mm ST elevation with a positive T-wave.

The diagnostic pattern may be present all the time, may occur spontaneously in response to as yet unclarified triggers, or may be elicited by the administration of class IC antiarrhythmic drugs that block sodium channels.

If this diagnosis is suspected, the patient should be referred to an electrophysiologist.  Treatment is placement of an implantable cardiac defibrillator.