Rapid Review·Cardiovascular
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Arrhythmias: Ventricular & Arrest
T3Take a glanceBrugada Syndrome
Focus on
A young Southeast Asian man with syncope or a family history of nocturnal sudden death, a structurally normal heart, and a pseudo-RBBB with coved ST elevation in V1–V3. Sodium-channel disease: treat fevers, avoid sodium-channel blockers, and put an ICD in anyone who has fainted or arrested.
Key takeaways
What it is
Brugada syndrome
an autosomal dominant defect of the cardiac voltage-gated sodium channel.Who
most common in adult men of Southeast Asian descent.Clinical features, diagnosis and management
Mostly asymptomatic
otherwise syncope, palpitations, dizziness.The danger
a raised risk of ventricular arrhythmias and sudden cardiac death.
What this shows
Electrocardiogram (ECG)
a pseudo-right bundle branch block with coved ST elevation in V1 to V3.Management
implantable cardioverter-defibrillator.A 35-year-old man from Thailand had an episode of syncope; his ECG shows an incomplete right bundle branch block pattern with coved ST elevation in V1 and V2. What is the channel defect and the treatment?
Brugada syndrome, an autosomal dominant sodium channel defect with a risk of ventricular arrhythmias and sudden death. Treat with an implantable cardioverter-defibrillator.
How it's tested
A 38-year-old Thai man faints at night; his brother died in his sleep at 35; ECG shows coved ST elevation in V1–V2 with an RBBB-like pattern and a normal echocardiogram: Brugada syndrome — ICD.
Same ECG found incidentally in an asymptomatic patient during a febrile illness: fever unmasked the pattern — treat the fever, avoid sodium-channel blockers, arrange follow-up and family screening; no ICD without symptoms.
Which drug should never be used to cardiovert a Brugada patient's atrial fibrillation: flecainide (or procainamide) — sodium-channel blockers provoke VF.
Brugada patient with repeated ICD shocks for VF storm: isoproterenol acutely, quinidine chronically.
Go deeper
Guidelines: 2017 AHA/ACC/HRS Ventricular Arrhythmias and Sudden Cardiac Death Guideline
Related Step 2 pages: Ventricular Tachycardia, Long QT Syndrome, Arrhythmogenic Right Ventricular Cardiomyopathy, Cardiac Implantable Devices, Approach to Syncope
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