UMEM Educational Pearls

Category: Cardiology

Title: Brugada Syndrome

Keywords: Brugada (PubMed Search)

Posted: 12/21/2014 by Semhar Tewelde, MD (Updated: 1/19/2015)
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Brugada Syndrome

Brugada syndrome is an inherited arrhythmogenic channelopathy described by ST-segment elevation in the right precordial leads and an increased risk of sudden cardiac death.

There are 3 electrocardiographic patterns:

Type 1 – Coved morphology w/ST-elevation >2 mm, followed by a negative T wave in at least 1 right precordial lead

Type 2 - Saddleback morphology w/ST-elevation >2mm, with a positive or biphasic T wave

Type 3 - Either coved, or saddleback morphology with <2mm ST-elevation

Type 1 pattern is often underestimated because of its sporadic/fluctuating appearance on ECG, which can be either spontaneously occurring or drug-induced (drug-induced variant has a more favorable prognosis).

Fever has been a well-documented culprit in unmasking Brugada pattern by increasing the sodium channel dysfunction & accelerating the late sodium current inactivation.

A recent study in a large population of patients with type 1 Brugada attempted to identify other patterns unmasking Brugada using 24-hour holter monitoring. * There is now evidence that there is a higher prevalence of type 1 Brugada pattern from 12pm-6pm & unmasking by fast and a large meal, showing influence by glucose intake and insulin levels. 




Cerrato N, Giustetto C, et al. Prevalence of Type 1 Brugada Electrocardiographic Pattern Evaluated by Twelve-Lead Twenty-Four-Hour Holter Monitoring. The American Journal of Cardiology.Vol 115, Issue 1, 1 Jan. 2015, pgs. 52-56.