Daily bolus of LR: Brugada syndrome

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February 7, 2011 by dailybolusoflr

Brugada syndrome is a rare disorder that is known for syncope or cardiac arrest related to ventricular dysrhythmias. 
Brugadas sign is the term used for the ECG findings noted in Brugada syndrome.
There are three types of variants recognized, which are based on the appearance of the ST segments in V1-V3.  A RBBB pattern has also been noted to be associated with Brugada syndrome but is not diagnostic. 
Type 1: J-point or ST segment elevations  >2 mm at its peak, followed by a
negative T wave, giving rise to a “coved” appearance.
Type 2:  J wave amplitude of > 2 mm, giving rise to a downsloping ST segment elevated   > or = 1 mm above
baseline resulting in a “saddle back” ST configuration.
Type 3: Has the same saddleback appearance as Type 2 variation, but the J-point elevation gives rise to a ST segment that is elevated < 1 mm above the baseline.
To diagnose Brugada syndrome, a type 1 pattern is needed.  If a type 2 or 3 pattern is found, challenge with a Na channel blocker and conversion into a type 1 pattern is needed.
8-27%  of patients with diagnosed Brugada syndrome with develop VT of sudden cardiac death in a 2-3 year follow up period.  The treatment of choice is placement of an ICD.
Gallague F, et al.  The Journal of Emergency Medicine, Vol. 37, No. 1, pp. 15–20, 2009
Linda Regan, MD FACEP
Program Director, Emergency Medicine Residency
Johns Hopkins Medical Institutions

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