Brugada syndrome: identification of subjects at risk and therapy

Figures

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  Figure 1. Electrocardiogram with spontaneous type 1 Brugada pattern.

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  Figure 2. Electrocardiographic criteria associated with increased arrhythmic risk in patients with spontaneous type 1 Brugada pattern. ECG, electrocardiogram.

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  Figure 3. Data from Gaita et al.12 Of 1149 asymptomatic patients, 539 (47%) showed a spontaneous type 1 pattern at the baseline electrocardiogram or at 12-lead 24-h Holter monitoring, while 610 (53%) had a drug-induced-only type 1 pattern; in the latter group, the absence of spontaneous type 1 pattern was confirmed by repeated electrocardiograms and multiple 12-lead Holter (with V1 and V2 leads recorded simultaneously on the IV, III, and II intercostal space), which were always negative. In the group of 539 patients with spontaneous type 1 pattern, 16 patients (3%) experienced an arrhythmic event during the follow-up (7 sudden deaths, 3 aborted sudden deaths, and 6 appropriate implantable cardioverter defibrillator interventions); in the group of 610 patients with drug-induced-only type 1 pattern, only 1 (0.16%) had an event (sudden death). ECG, electrocardiogram; ICD, implantable cardioverter defibrillator.

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  Figure 4.. On the left, the percentages of patients according to clinical presentation, the presence of spontaneous type 1 electrocardiogram pattern and result of the electrophysiological study (47% asymptomatic patients with drug-induced-only type 1 electrocardiogram pattern; 29% asymptomatic patients with spontaneous type 1 pattern and negative electrophysiological study; 12.5% asymptomatic patients with positive electrophysiological study; 9.9% patients with unexplained syncope; and 1.6% patients with resuscitated cardiac arrest). On the right, the annual risk of arrhythmic events at follow-up for each subgroup. Based on this distribution, approximately one in four patients deserves treatment. ECG, electrocardiogram; EPS, electrophysiological study.