Brugada Syndrome: EKG findings

You always hear about it when working up syncope and sudden cardiac arrest in young patients, but it's so easy to forget what it looks like on EKG. We so rarely see it... or DO we?!

This Brugada Syndrome is to help emblazon these EKG tracings in our mind, so that we don't miss the subtle findings which place a patient at risk for sudden cardiac death. Pay special attention to Type 1, which is most specific for Brugada Syndrome.

Brugada Syndrome

1. Genetically linked, cardiac sodium channelopathy
2. High risk for sudden death in young, healthy adults because VTach/VFib
3. Mean age of sudden death = 41 ± 15 years
4. Higher prevalence in males and Asian descent
5. Atrial fibrillation associated in 10-20% cases

EKG findings: 3 types

Type 1 – Most specific for Brugada Syndrome

    – Highest risk for symptoms of syncope and sudden death

Differential diagnosis:

• After electrical cardioversion 
• Arrhythmogenic RV dysplasia 
• Atypical right BBB
• Acute MI, esp RV infarct
• Acute myopericarditis
• Compression of RV outflow tract 
• Disorders of central/auton nerv systems 
• Dissecting aortic aneurysm
• Duchenne muscular dystrophy
• Friedreich ataxia 
• Early repolarization, especially in athletes 
• Hypothermia
• Pericardial effusion 
• Pulmonary embolism
• Left ventricular hypertrophy 
• Mediastinal tumor 
• Pectus excavatum 

Treatment:

Implantable cardiac defibrillator for Brugada Type 1 PLUS:

• Aborted sudden cardiac death
• Syncope, seizure, or noctural agonal respirations without alternative cause
• Family hx of sudden cardiac death (likely from Brugada) AND positive EPS study
• A positive EPS study

-- Otherwise: close followup with cardiologist

by

AKSHAYA SRIKANTH

Pharm.D

India