Brugada syndrome - Case report, risk stratification and treatment

Brugada syndrome (BrS) is a malignant, genetically-determined, arrhythmogenic syndrome that is characterized by abnormal electrocardiogram (ECG) findings and an increased risk of sudden cardiac death (SCD). BrS is responsible for about 4% of all sudden deaths and up to 20% of sudden deaths among patients with structurally normal hearts. Since the first report on BrS in 1992 by the Spanish cardiologists Pedro and Josep Brugada, there are still some unresolved clinical problems as risk stratification (RS) and identification of those patients at high risk of SCD who need implantable cardioverter-defibrillator (ICD). All recommendations are based on expert opinion, there is still no validated algorithm for RS of asymptomatic patients (low prevalence, no randomized controlled trials). Electro-anatomic mapping studies have revealed, for the first time, an arrhythmogenic substrate over the right ventricular outflow tract (RVOT) in BrS patients. Better understanding of the genetic and electrophysiological changes underlying BrS are needed for RS of asymptomatic BrS patients in preventing morbidity and mortality. In this article we present a case of 42-year old man with Brugada type ECG that was recorded after sudden cardiac arrest and briefly summarize current knowledge about the ECG based methods for diagnosis and emphasize risk factors for RS and options in treatment BrS patients. (C) 2016 The Czech Society of Cardiology. Published by Elsevier Sp. zo.o. All rights reserved.