Abstract
Brugada and Brugada reported in 1992 eight patients with a history of aborted sudden cardiac death due to ventricular fibrillation (VF) and a characteristic electrocardiographic pattern, consisting of right bundle branch block (RBBB) and ST-segment elevation in the right precordial electrocardiogram (ECG) (V1-V3) as a distinct clinical entity.1, 2, 3, 4, 5, 6, 7, 8 The presence of RBBB was thereafter revealed to be not necessary for the diagnosis of Brugada syndrome, although mild to moderate widening of the QRS duration is often observed.5 Two specific types of ST-segment elevation, coved and saddleback, are observed in this syndrome. The ST-segment elevation is often accentuated and the coved type ST-segment elevation is more frequently recognized just before and after episodes of VF.9,10 The Brugada Consensus Report in 2002 suggested three patterns of ST-segment elevation in the right precordial ECG.5 Type 1 is characterized by a coved type ST-segment elevation displaying J wave amplitude or ST-segment elevation of ≥0.2mV followed by a negative T wave (Figure 47-1A). Type 2 has a saddleback configuration, which has a high takeoff ST-segment elevation (≥0.2mV) followed by a gradually descending ST-segment elevation (remaining ≥0.1mV above the baseline) and a positive or biphasic T wave (Figure 47-1B). Type 3 has an ST-segment elevation of <0.1 mV of the saddleback, coved type, or both. The second Consensus Report published in 2005, however, emphasized that Type 1 coved ST-segment elevation is required to diagnose Brugada syndrome,7 because the Type 1 ECG is reported to relate to a higher incidence of VF and sudden cardiac death.6 Type 2 and Type 3 ST-segment elevation are not diagnostic for the Brugada syndrome. The recordings of V1 and V2 leads at higher (third and second) intercostal spaces increase the sensitivity and the specificity of the ECG diagnosis for detecting the Brugada phenotype (Figure 47-1C),7,11 and their diagnostic and prognostic values have recently been reported.12
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