ST Segment Elevation on Electrocardiogram: The Electrocardiographic Pattern of Brugada Syndrome

Ali A. Sovari, MD; Marilyn A. Prasun, RN, PhD; Abraham G. Kocheril, MD, FAC C, FACP

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Treatment

Although a pharmacologic approach, such as treatment with amiodarone, has been shown to be effective to some degree, the implantable cardioverter defibrillator (ICD) is the mainstay of the therapy. ICD therapy is recommended for patients with a type 1 Brugada ECG pattern who are symptomatic. Other etiologies for symptoms such as syncope, and seizure should be ruled out before considering these symptoms as being secondary to Brugada syndrome. For asymptomatic patients, Antzelevitch and colleagues[5] suggest dividing them into 2 main categories: (1) those with a spontaneously occurring type 1 Brugada pattern, and (2) those showing a type 1 Brugada pattern after procainamide challenge. EPS is recommended for all patients in group 1 and for patients in group 2 who have a family history of SCD. If any VT is inducible in EPS, an ICD should be implanted to prevent SCD.[5] Although this approach is recommended by some experts, risk stratification in Brugada syndrome is controversial. For instance the results of a recent meta-analysis of 30 prospective studies of Brugada syndrome suggests that a history of syncope or SCD, the presence of a spontaneous type I Brugada ECG pattern, and male gender carry poorer prognosis with more frequent events while a family history of SCD, the presence of an SCN5A gene mutation, or inducible VT in EPS may not have a prognostic value.[9]

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