Clinical Notes : Cardiology

116. ECG - Brugada

ECG - Brugada

Key Points : 

  • There’s really only one type of Brugada syndrome.

  • Diagnosis depends on a characteristic ECG finding AND clinical criteria.

  • Further risk stratification is controversial.

  • Definitive treatment = ICD.

  • Brugada sign in isolation is of questionable significance.

Etiology :

​In a nutshell, Brugada syndrome is due to a mutation in the cardiac sodium channel gene. This is often referred to as a sodium channelopathy.

ECG changes can be transient with Brugada syndrome and can also be unmasked or augmented by multiple factors:

  • Fever

  • Ischaemia

  • Multiple Drugs

    • Sodium channel blockers eg: Flecainide, Propafenone

    • Calcium channel blockers

    • Alpha agonists

    • Beta Blockers

    • Nitrates

    • Cholinergic stimulation

    • Cocaine

    • Alcohol

  • Hypokalaemia

  • Hypothermia

  • Post DC cardioversion

 

Diagnostic criteria :

Type 1 (Coved ST segment elevation >2mm in >1 of V1-V3 followed by a negative T wave) is the only ECG abnormality that is potentially diagnostic. This has been referred to as Brugada sign.

 
 
 

Brugada sign

This ECG abnormality must be associated with one of the following clinical criteria to make the diagnosis:

  • Documented ventricular fibrillation (VF) or polymorphic ventricular tachycardia (VT).

  • Family history of sudden cardiac death at <45 years old .

  • Coved-type ECGs in family members.

  • Inducibility of VT with programmed electrical stimulation .

  • Syncope.

  • Nocturnal agonal respiration

 

The other two types of Brugada are non-diagnostic but possibly warrant further investigation.

Brugada Type 2: has >2mm of saddleback shaped ST elevation.

Brugada Type 2

Brugada Type 3: can be the morphology of either type 1 or type 2, but with <2mm of ST segment elevation.

 

Brugada Type 3

 
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