3.Discussion
Brugada pattern describes asymptomatic patients with ECG finding of a pseudo-right bundle branch block and persistent ST segment elevation in leads V1 to V2 with no other clinical criteria. It can be discovered in casual ECG or as part of the screening of first-degree relatives of a Brugada proband. There are two main types of Brugada ECG patterns:
Type 1: the elevated ST segment ≥ 2mm descends with an upward convexity to an inverted T wave. This is referred to as the “coved type” Brugada pattern.
Type 2: the ST segment has a “saddle back” ST-T wave configuration, in which the elevated ST segment descends toward the baseline, then raises again to an upright or biphasic T wave.
In some patients, the characteristic ECG changes of the Brugada pattern are transient or variable over time. Provoking factors are:
Brugada syndrome is symptomatic Brugada pattern with one or more of these clinical criteria:
Arrhythmic events generally occur between the ages 22 and 65 years and peak between 38 and 48 years. They are rare in children. However, patients with ventricular premature beats or non-sustained ventricular tachycardia are generally not considered as Brugada syndrome but Brugada pattern.
Management of Brugada pattern patients:
  1. Additional tests to exclude underlying heart disease (eg, myocardial ischemia).
  2. Risk evaluation: electrophysiology testing, signal-averaged ECG, 12-lead ECG and drug challenge in specific cases.
  3. Genetic testing (eg, SCN5A, SCN10a genes) for Brugada syndrome probands.
  4. Implantable cardioverter-defibrillator (ICD) in case one of:
Fever is a common source for Brugada pattern, a study assessed the prevalence of Brugada pattern in consecutive patients with fever depending on EKGs of 402 patients with fever and 909 others without fever, Eight of 402 patients with fever, but only 1 of 909 afebrile patients, had a type I Brugada pattern. Thus, a type I Brugada pattern was 20 times more prevalent among febrile patients (2% vs 0.1%, p= .0001). All patients with fever-induced type I Brugada pattern were asymptomatic and remained so during 30 months of follow-up. The study concluded that type I Brugada pattern is definitively more common among patients with fever, suggesting that asymptomatic Brugada pattern is more prevalent than previously estimated (4).