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Assessment of noninvasive markers in identifying patients at risk in the brugada syndrome: insight into risk stratification

Takanori Ikeda, MD, FACC^*, Harumizu Sakurada, MD, Koichi Sakabe, MD^*, Takao Sakata, MD^*, Mitsuaki Takami, MD^*, Naoki Tezuka, MD^*, Takeshi Nakae, MD^*, Mahito Noro, MD^*, Yoshihisa Enjoji, MD^*, Tamotsu Tejima, MD, Kaoru Sugi, MD^* and Tetsu Yamaguchi, MD^*

^* Third Department of Internal Medicine, Ohashi Hospital, Toho University School of Medicine, Tokyo, Japan
Division of Cardiology, Tokyo Metropolitan Hiroo General Hospital, Tokyo, Japan

View larger version (81K): [in a new window]   Figure 1 Twelve-lead electrocardiogram from a patient with a pattern of right bundle branch block and ST-segment elevation in leads V1 through V3. The configuration of the ST-segment in leads V1 to V2 is a coved type. Absence of a widened S-wave and a wide QRS complex in the left lateral leads suggests that this is not a true right bundle branch block. The QT interval and the corrected QT interval are normal (408 ms and 414 ms, respectively).

View larger version (37K): [in a new window]   Figure 2 Polymorphic ventricular tachycardia generating into ventricular fibrillation induced by programmed electrical stimulation without the use of antiarrhythmic drugs in a patient with Brugada syndrome and several syncopal episodes. This patient required cardioversion for termination of this rhythm. HBE = His bundle electrogram; HRA = high right atrium; RVA = right ventricular apex.

View larger version (49K): [in a new window]   Figure 3 Electrocardiographic tracings in leads V1 through V3 and the signal-averaged electrocardiogram for a patient with Brugada syndrome and syncopal episodes. The late potentials, represented by the shaded area, are positive, showing an RMS40 <20 µV, and an LAS40 >38 ms.