Overview
Brugada syndrome is an inherited condition that strongly predisposes to sudden cardiac death. The condition is autosomal dominant in inheritance and involves a loss of function mutation in sodium channels, predominantly affecting the right ventricle.
Pathogenesis
Drug Triggers of Arrhythmia in Brugada Syndrome
- Antiarrhythmics - flecainide, procainamide
- Psychotropics - amitriptyline, nortriptyline, lithium
- Anaesthetics - local anaesthetics, propofol
- Substances - alcohol, cannabis, cocaine
Diagnosis
ECG Findings
All findings must occur in at least one right precordial lead (V1-V3).
- Type 1 - coved ST elevation >2mm in V1-V3, followed by a negative T wave
- Type 2 - saddle-shaped ST elevation in V1-V3 that is >2mm at the J point and >=1mm at the terminal portion of the ST segment
- Type 3 - saddle-shaped ST elevation in V1-V3 that is >2mm at the J point and <1mm at the terminal portion of the ST segment
The presence of a type 1 pattern with at least one clinial criterion is diagnostic of Brugada syndrome.
Clinical Criteria for Diagnosis
At least one of:- Documented VT / VF
- FHx sudden cardiac death <45 years
- Coved ECGs in family members
- Inducibility of VT with programmed electrical stimulation
- Syncope
- Nocturnal agonal respiration
The Brugada pattern in isolation is of unclear clinical significance, while the presence of clinical criteria with a type 2 or 3 pattern requires further investigation.
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