What it is
Brugada syndrome is an inherited sodium-channelopathy (most often SCN5A mutations) causing a risk of polymorphic VT/VF and sudden cardiac death in a structurally normal heart. It classically presents with syncope or nocturnal sudden death in young or middle-aged adults, more commonly men, and is over-represented in South-East Asian populations.
ECG pattern
Type 1 (diagnostic):
- Coved (downsloping) ST elevation ≥ 2 mm in V1–V2
- ST segment descends into a negative T wave
- Resembles a right bundle branch block but without the wide S wave in the lateral leads
Types 2 and 3 have a saddleback morphology — suggestive, not diagnostic, and may need drug provocation (e.g. ajmaline/flecainide) or high right-precordial lead placement to unmask a type 1 pattern.
Triggers that unmask it
- Fever (classic — treat pyrexia promptly)
- Sodium-channel blockers: flecainide, tricyclic antidepressants
- Cocaine, excess alcohol, electrolyte disturbance
Management
- Risk-stratify: prior cardiac arrest, syncope, or a spontaneous type 1 pattern mark high risk
- ICD is the only proven therapy for high-risk patients
- Quinidine may reduce arrhythmia burden; avoid provoking drugs; treat fever aggressively
- Family screening (autosomal dominant)
See a real 12-lead example
For an annotated tracing of this pattern, see the Brugada Syndrome page in the LITFL ECG Library:
ECG image examples are hosted by Life in the Fast Lane (LITFL), whose ECG library is published under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 licence. We link to LITFL rather than reproducing their tracings. The teaching notes above are original and written independently for MedNotes Hub.