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The Brugada syndrome: risk stratification.
Fiorenzo Gaita1,2, Natascia Cerrato3, Andrea Saglietto2,4
1Maria Pia Hospital, GVM Care & Research, Strada Comunale di Mongreno 180, 10132 Turin, Italy.
Summary
Spontaneous type 1 Brugada ECG pattern (BrECG) is a key risk marker. Repeated Holter monitoring is crucial for detecting this pattern and assessing arrhythmic event risk in Brugada syndrome patients.
Area of Science:
- Cardiology
- Clinical Electrophysiology
Background:
- Brugada syndrome knowledge has advanced significantly since its initial description.
- The spontaneous type 1 ECG pattern (BrECG) is a recognized prognostic indicator in asymptomatic individuals.
Purpose of the Study:
- To emphasize the importance of detecting spontaneous type 1 BrECG.
- To highlight optimal diagnostic strategies for Brugada syndrome.
- To discuss additional ECG markers and the role of electrophysiological studies.
Main Methods:
- Utilizing periodic ECGs and repeated 12-lead 24-hour Holter monitoring with specific electrode placements (V1-V2 on 2nd/3rd intercostal space).
- Considering Holter monitoring before drug challenge (sodium channel blockers) in cases of dubious BrECG.
- Identifying additional ECG markers like first-degree AV block, QRS fragmentation, S wave in leads I/II, and prolonged QRS duration.
Main Results:
- Spontaneous type 1 BrECG is associated with double the risk of arrhythmic events compared to drug-induced patterns.
- Extreme variability of ECG patterns necessitates careful and repeated assessments.
- Other ECG findings indicate increased arrhythmic risk.
Conclusions:
- Spontaneous type 1 BrECG is a critical prognostic marker requiring diligent detection through Holter monitoring.
- The role of electrophysiological studies in asymptomatic patients with spontaneous BrECG remains under investigation.
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