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23-43: Brugada Syndrome

Maite A. Huis in ‘t Veld; Amal Mattu; R. Jason Thurman

ECG Findings

  • Incomplete or complete RBBB pattern in leads V1 and V2 with ST-segment elevation.

  • There are two types of ST elevation: (1) the type I pattern has ST elevation that is convex upward, terminating in a negative T wave; this is the most sensitive and specific pattern; (2) the type II pattern has ST elevation that is concave upward (saddleback pattern) and is less sensitive and less specific.

Pearls

  1. Brugada syndrome is thought to be a sodium channelopathy.

  2. Patients with Brugada syndrome are at risk for spontaneous arrhythmias and sudden cardiac death.

  3. ECG changes in Brugada syndrome patients are transient and often unmasked by fever, ischemia, and sodium channel–blocking drugs.

  4. Consultation with a cardiologist is recommended for electrophysiologic testing and automated implantable defibrillator placement.

FIGURE 23.43A

Brugada Syndrome. (ECG contributors: Clifford L. Freeman, MD, and Nicole S. McCoin, MD.)

An E C G tracing with 12 leads from a patient with Brugada syndrome.
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FIGURE 23.43B

RBBB pattern with ST elevation (type I Brugada syndrome).

An E C G tracing with two leads depicts S T elevation. Leads V 1 and V 2 consist of a small, sharp peak, a wide, sharp peak, and a curved dip.
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FIGURE 23.43C

ST elevation with “saddleback” morphology (arrow) (type II Brugada syndrome).

An E C G tracing of lead V 2, consists of a curved peak, a sharp peak, a sharp dip, and a small, curved dip. An arrow points down to the small dip.
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