Current electrocardiographic criteria for diagnosis of Brugada pattern: a consensus report☆
Section snippets
Concept
Brugada syndrome (BrS)1 is a familial, genetically determined syndrome characterized by autosomal dominant inheritance in about 50% of cases with variable penetrance. More than 70 mutations, most commonly in the cardiac Na+ channel, have been described. In around 20% of cases, there are SCN5A mutations that explain the accelerated inactivation of Na channels.2
The diagnosis of BrS is suggested by the clinical history in a patient with specific electrocardiographic (ECG) pattern (Brugada pattern
ECG abnormalities of the BrP
Firstly, we have to say that the abnormal ECG constitutes the hallmark of BrS; but it is necessary to emphasize that the ECG changes can be dynamic and sometimes are concealed. Indeed, the ECG BrP is sometimes intermittent; and it may be observed only in certain situations, such as fever, intoxication, vagal stimulation, and electrolyte imbalance (Table 1).17, 18 Furthermore, there are some drugs (sodium channels blockers) that may unmask a BrP.19 The ECG pattern characteristic of BrS that may
Differential diagnosis
We have to distinguish (a) the cases of spontaneous typical BrP type 1 in case of BrS; (b) the typical BrP type 1 induced by some drugs (sodium channel blockers) or other circumstances (fever, etc) that unmask a BrS; (c) the cases of ECG BrP especially type 1 induced by many circumstances that disappear upon resolution of the injury and that do not present BrS (named phenocopies) (These include acute ischemia, pericarditis, myocarditis, pulmonary embolism, metabolic disorders, ionic disorders,
Conclusions
We have exposed the current ECG criteria of BrP, including the ones described after the last consensus statement,24, 25 which have very high accuracy and could used by nonexperienced physicians for a reliable diagnosis of both types of BrP, especially type 1. The most important points are the following:
- 1.
Only 2 ECG patterns should be considered: type 1 (coved type) and type 2 (saddle-back type) that encompass the patterns 2 and 3 of previous consensus (Table 2).
- 2.
In both types 1 and 2, the end of
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