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ECG Disease Patterns
 
 

Brugada Syndrome

 
 
 
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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.
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  • ECG Findings in Brugada Syndrome

  • 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.
  • Drug Triggers of Arrhythmia in Brugada Syndrome

  • Antiarrhythmics - flecainide, procainamide
  • Psychotropics - amitriptyline, nortriptyline, lithium
  • Anaesthetics - local anaesthetics, propofol
  • Substances - alcohol, cannabis, cocaine
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