The Brugada syndrome: risk stratification. (26th April 2023)

• Record Type: Journal Article
• Authors: Gaita, Fiorenzo; Cerrato, Natascia; Saglietto, Andrea; Caponi, Domenico; Calò, Leonardo; Giustetto, Carla
• Is Part Of: European heart journal supplements. Volume 25(2023)Supplement C
• Page Start: C27
• Page End: C31
• Publication Date: 2023-04-26
• Subjects: Brugada syndrome -- Risk stratification -- Electrophysiological study; Cardiology -- Periodicals; Cardiology -- Europe -- Periodicals; 616.12005
• DOI: 10.1093/eurheartjsupp/suad035
• Languages: English
• ISSNs: 1520-765X

Abstract

Abstract: Thirty years after its first description, the knowledge regarding Brugada syndrome has greatly increased. Spontaneous type 1 ECG pattern (BrECG) is a well-defined prognostic marker in asymptomatic patients and is associated with a double risk of arrhythmic events during follow-up as compared to drug-induced ECG pattern. Due to the extreme variability of the ECG pattern over time, the spontaneous type 1 BrECG must be carefully sought, not only through periodic ECGs but especially with repeated 12-lead 24-h Holter monitoring, with V1 and V2 electrodes placed also on the second and third intercostal space, in order to explore the right ventricular outflow tract. 12-lead 24-h Holter should also be performed in all the patients with a dubious BrECG pattern even before the drug challenge with sodium channel blockers, which carries a low but definite risk of complications. In addition to spontaneous type 1, other electrocardiographic markers of increased arrhythmic risk have been described, such as first-degree AV block, QRS fragmentation, S wave in lead I and II, and increased QRS duration. The electrophysiological study in asymptomatic patients with a spontaneous ECG Brugada pattern is still under jury and further studies need to clarify its precise role.