Risk Assessment in Brugada-Syndrome: The Way Back to the Surface ECG

摘要

The Brugada syndrome (BrS) is recognized as an important cause of sudden cardiac death in young apparently healthy individuals.It is diagnosed from the 12-lead surface ECG with particular emphasis on the right precordial or, rarely, the inferior leads where an atypical right ventricular conduction delay with coved-type ST segment elevation can be found. A challenge in the diagnostic set-up is the transient appearance of these ECG changes that can be provoked by external or environmental factors or intentionally after administration of class I antiarrhythmic agents.Over the past years, a variable and less severe clinical course has been observed in many patients with BrS that is probably more common than initially thought. Thus, many efforts have been undertaken in the search for invasive and noninvasive clinical markers that can be used for risk stratification in BrS patients to identify those who are in danger of potentially fatal ventricular tachyarrhythmias. Using induction of ventricular arrhythmias during programmed ventricular stimulation as a predictor for clinical events is a matter of an ongoing debate,and a recent meta-analysis indicated it had no particular prognostic impact.Also, neither a positive family history of sudden death nor classification into specific genetic subtypes (e.g., carriers of mutations in the SCN5A gene) have been proven to be reliable risk predictors