Brugada Syndrome Medical Slides

Show side-by-side ECGs: Type 1 (coved) shows ≥2 mm J-point elevation with gradual descending ST segment leading directly into inverted T wave in ≥1 right precordial lead (V1-V2) — this is the only diagnostic pattern. Type 2 (saddleback) has ≥0.5 mm J-point elevation with positive or biphasic T wave and is suggestive but non-diagnostic, requiring sodium channel blocker provocation test to unmask Type 1.

Fever is a well-documented trigger for Type 1 Brugada pattern unmasking and ventricular arrhythmias because elevated temperature further impairs sodium channel function in SCN5A mutation carriers. Teach that aggressive antipyretic therapy (acetaminophen, cooling measures) is essential, and that febrile illness accounts for a significant proportion of Brugada-related cardiac events. Patients should carry alert cards and avoid temperatures >38.5°C.

Present the controversy: ICD is Class I for cardiac arrest survivors and Class IIa for spontaneous Type 1 ECG with syncope history. For asymptomatic patients with spontaneous Type 1, the 2022 expert consensus recommends EP study with programmed stimulation, but its predictive value is debated. Discuss the ongoing BRUGADA-ICD registry data showing annual event rates of 0.5% in asymptomatic patients versus the 5% long-term ICD complication rate, framing this as a genuine shared decision-making scenario.