What are the key clinical features and diagnostic criteria for Brugada Syndrome that I should be aware of in my practice?

Key clinical features of Brugada Syndrome include episodes of syncope or sudden cardiac arrest, often occurring in otherwise healthy individuals, typically in adulthood. Patients may present with palpitations, nocturnal agonal respiration, or unexplained sudden death in family history. The syndrome is more common in males and may be unmasked or exacerbated by fever, certain medications, or metabolic disturbances.

Diagnostic criteria primarily rely on characteristic electrocardiogram (ECG) findings combined with clinical features. The hallmark ECG pattern is a coved-type ST-segment elevation ≥2 mm in at least one right precordial lead (V1–V3) positioned in the 2nd, 3rd, or 4th intercostal space, followed by a negative T wave (type 1 Brugada pattern). This pattern may be spontaneous or induced by sodium channel blocker challenge (e.g., ajmaline, flecainide).

Diagnosis requires the type 1 ECG pattern plus one or more of the following: documented ventricular fibrillation or polymorphic ventricular tachycardia, family history of sudden cardiac death under 45 years, coved-type ECG in family members, inducibility of ventricular arrhythmias during electrophysiological study, syncope suggestive of arrhythmia, or nocturnal agonal respiration.

Structural heart disease is typically absent, supporting its classification as a primary electrical disease, although recent evidence suggests subtle structural alterations may coexist Oliva et al. 2022. In practice, recognition of the ECG pattern and clinical context is critical for diagnosis and risk stratification.

In summary, be vigilant for unexplained syncope or sudden death in young adults, especially males, and confirm diagnosis with characteristic ECG changes and clinical criteria as outlined above NICE CKS Benito et al. 2008Escárcega et al. 2009Oliva et al. 2022.