Brugada syndrome and Brugada sign: Clinical spectrum with a guide for the clinician

Background Patients with the manifest Brugada syndrome have an inordinate risk of sudden death sand are candidates for implantation of a defibrillator. The Brugada type electrocardiogram (ECG) abnormality (the Brugada sign), however, is known to de associated with a wide range of conditions, many of which may not pose such a threat. Clinicians need guidance in choosing a rational approach for the evaluation and treatment of patients with a finding of the Brugada sign. Methods A systematic literature search was performed to identify publications on the Brugada syndrome and the Brugada-type ECG abnormality, with special emphasis on analyzing outcomes data. En addition, the ECG database of our institution was reviewed for tracings consistent with the Brugada sign, and, when possible, clinical correlations were made. Results Patients with the Brugada sign and a family history of sudden death or a personal history of syncope are at a high risk of sudden death sand therefore should de strongly considered for implantation of a defibrillator. In patients who are hospitalized and critically ill, the Brugada sign is frequently the result of severe hyperkalemia, drug toxicity, or right ventricular injury. In most individuals with no symptoms and without a family history of sudden death, the Brugada sign is likely a normal variant. Conclusions Most patients with tie Brugada sign cars be risk-stratified with simple clinical tools. Specific testing for the Brugada syndrome should de reserved for questionable cases and for the research setting. A provisional diagnostic-therapeutic algorithm is offered as a means of assisting the clinician in the evaluation and treatment of patients with the Brugada sign.