Brugada syndrome classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sogand Goudarzi, MD [2]

Overview

There are three electrocardiographic patterns associated with Brugada syndrome: Type I, Type II and Type III. The diagnosis of Brugada syndrome is based upon the presence of Type I EKG changes. Patients with Type II or Type III Brugada patterns can convert to a Type I Brugada pattern following the administration of sodium channel blockers such as ajmaline and flecainide. To be classified as having Brugada syndrome (not just the pattern), one or more of the following criteria must also be met:

The patient is also diagnosed as having Brugada syndrome when a Type 2 (saddleback pattern) or Type 3 ST-segment elevation is observed in more than one right precordial lead under baseline conditions that can be converted to the diagnostic Type 1 Brugada pattern following administration of a sodium channel blocker and the clinical criteria listed above are met as well.

Classification

  • The three patterns of Brugada syndrome (Type I,II,III) are shown below:

The table below is from ECGpedia and is adapted from Wilde et al.[5]

ST segment abnormalities in the different types of Brugada syndrome
Type I Type II Type III
J wave amplitude >= 2mm >= 2mm >= 2mm
T wave Negative Positive or biphasis Positive
ST-T configuration Coved type Saddleback Saddleback
ST segment (terminal portion) Gradually descending Elevated >= 1mm Elevated < 1mm

References

  1. Tse, Gary; Liu, Tong; Li, Ka H. C.; Laxton, Victoria; Chan, Yin W. F.; Keung, Wendy; Li, Ronald A.; Yan, Bryan P. (2016). "Electrophysiological Mechanisms of Brugada Syndrome: Insights from Pre-clinical and Clinical Studies". Frontiers in Physiology. 7. doi:10.3389/fphys.2016.00467. ISSN 1664-042X.
  2. Brugada J, Brugada P, Brugada R (October 2001). "Brugada syndrome: the syndrome of right bundle branch block, ST segment elevation in V1 to V3 and sudden death". Indian Pacing Electrophysiol J. 1 (1): 6–11. PMC 1569891. PMID 17006566.
  3. Antzelevitch, Charles; Yan, Gan-Xin; Ackerman, Michael J.; Borggrefe, Martin; Corrado, Domenico; Guo, Jihong; Gussak, Ihor; Hasdemir, Can; Horie, Minoru; Huikuri, Heikki; Ma, Changsheng; Morita, Hiroshi; Nam, Gi-Byoung; Sacher, Frederic; Shimizu, Wataru; Viskin, Sami; Wilde, Arthur A.M. (2016). "J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge". Europace: euw235. doi:10.1093/europace/euw235. ISSN 1099-5129.
  4. García-Fuertes, Daniel; Villanueva-Fernández, Elena; Crespín-Crespín, Manuel; Puchol, Alberto; Pachón, Marta; Arias, Miguel Angel (2016). "Type 1 Brugada Pattern Unmasked During the Recovery Period of an Exercise Stress Test". Arquivos Brasileiros de Cardiologia. doi:10.5935/abc.20160071. ISSN 0066-782X.
  5. Wilde AA, Antzelevitch C, Borggrefe M, Brugada J, Brugada R, Brugada P, Corrado D, Hauer RN, Kass RS, Nademanee K, Priori SG, Towbin JA (2002). "Proposed diagnostic criteria for the Brugada syndrome: consensus report". Circulation. 106 (19): 2514–9. PMID 12417552. Retrieved 2012-10-14. Unknown parameter |month= ignored (help)


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