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Electrocardiograms You Need to Know: Brugada Syndrome

BS is a potentially important but not yet well defined entity that should be on the ED radar, but confirming the diagnosis is difficult. Most of the literature regarding this abnormality surfaced within the past seven years or so, making it a new syndrome. Brugada syndrome is one zebra that most EPs have never heard about, don't look for, and like the rest of the world, don't currently understand. Perhaps the takeaway message is to look specifically for an atypical right bundle branch block on the cardiogram, coupled with curiously elevated ST segment in V1-V3, in someone with syncope, palpitations, supraventricular arrhythmias, or after surviving cardiac arrest. If fortuitously noted in the…

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  Brugada Syndrome: An ECG Pattern You Need to Know

Brugada Syndrome is an uncommon entity, that can mimic STEMI, has a high rate of sudden cardiac death, and currently ICD placement is the best treatment strategy.

 Brugada Syndrome: 3-Step Approach to Diagnosis and Management

ECG interpretation of Brugada pattern: type 1 (coved) is pathognomonic, but type 2 (saddle-back) requires checking lead placement (negative P in V1 or biphasic P in V2 are too high) and measuring the base of the triangle (>4mm measured 5mm from the apex of r’).

 ECG Pointers: Syncope and Brugada Syndrome

Even asymptomatic, anyone with an ECG consistent with Brugada’s syndrome has an 8% risk of sudden death over the next 2 years. Implantable defibrillator is the only treatment that has been shown to reduce mortality of Brugada syndrome.

 POTD: Brugada Syndrome

Quinidine is the best studied medication for tachyarrhythmias in Brugada, terminating 80% of arrhythmias. (Interestingly it is a Na channel blocker, but it's blockade effect on Ito an outflowing K channel is what helps it treat Brugada). Immediate release form 200-400 mg PO q6h, then extended release 324 mg PO q12. Isoproterenol (B1/B2 agonist) is less studied but it can be given as a drip at 2-10 mcg/min tritrated to effect.

 What is Brugada Syndrome?

Brugada Syndrome is an ECG abnormality with a high incidence of sudden death in patients with structurally normal hearts.

Articles of Interest

Is this Type 2 Brugada syndrome/ECG pattern?

Types 2 and 3 Brugada have been merged into Type 2. The diagnoses have been perplexing for years because they have been based on a "saddleback" morphology. However, saddleback morphology is a very common normal variant: "saddleback" morphology is rarely Brugada pattern and even more rarely Brugada syndrome.

You Gotta Know Brugada

Brugada Pattern EKG is NOT ALWAYS pathalogical. Brugada pattern EKG can be a normal variant, especially in a patient without risk factors, symptoms, and the pattern is an incidental finding during a non-cardiac workup.

Brugada Syndrome: A Look at the “Might Be” and “Maybe” in Diagnosis and Treatment

Currently, implantation of an ICD is the only effective treatment for this syndrome. However, risk stratification of asymptomatic patients with Brugada type ECG is still a challenge.

Classic ECG Pattern

compliments BC Emergency Medicine

Drugs to be avoided by Brugada syndrome patients

The following drugs have been associated with arrhythmias and the typical (type-1) Brugada syndrome ECG. Therefore the BrugadaDrugs.org Advisory Board strongly advices to avoid these drugs in Brugada syndrome patients or to use these drugs only after extensive consideration and/or in controlled conditions.

Management of patients with a Brugada ECG pattern

The correct recognition and management of these patients should be considered an essential skill for any cardiologist. Learn to recognise and treat these patients in six steps.

Resources

BrugadaDrugs.org

BrugadaDrugs.org is a non-profit initiative developed by physicians from the University of Amsterdam Academic Medical Center, department of Cardiology, in collaboration with a panel of world-renowned experts on Brugada syndrome as an aid to physicians who treat patients with Brugada syndrome and as an aid to patients with Brugada syndrome and their families with the goal to provide free, worldwide accessible and up-to-date information on safe drug use in Brugada syndrome.

Core EM

An inherited disorder that predisposes patients to sudden cardiac death by ventricular arrhythmia that is characterized by the following EKG pattern: ST segment elevation with Type 1 Brugada morphology ≥ 2mm in ≥ 1 of the right precordial leads (V1 or V2), spontaneously or after provocative test with intravenous class I anti-arrhythmic medication Type 1 Brugada morphology defined as cove-shaped ST segment elevation ≥ 2mm followed by inverted T wave

ECGpedia.org

The Brugada syndrome is an hereditary disease that is associated with high risk of sudden cardiac death. It is characterized by typical ECG abnormalities: ST segment elevation in the precordial leads (V1 - V3).

Life in the Fastlane

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