Brugada syndrome: where are you?

Brugada syndrome is an arrhythmogenic disease characterized by a typical electrocardiographic (ECG) pattern with ST-segment elevation in the right precordial leads and an increased risk of sudden cardiac death related to polymorphic ventricular tachyarrhythmias or ventricular fibrillation.1 The cornerstone for the diagnosis of the syndrome is the presence of the typical type 1 ECG pattern characterized by the presence of a coved ST-segment elevation of at least 2 mm (0.2 mV) followed by the negative T-wave in two right precordial leads (V1—V3).2Although the first and second consensus conferences provided clarification of the diagnosis criteria that are supposed to facilitate recognition of the disease, wide variations in the ECG interpretations still persist for this disease.2,3 For example, in the French study COBRA, 20% of the ECGs referred to the expert committee with a Brugada syndrome diagnosis were not in fact diagnostic for the disease.4 Why is it so difficult to diagnose Brugada syndrome? One of the main difficulties is the fact that in contrast to what is found for the long QT … *Corresponding author: Service de cardiologie du CHU de Nantes, CHU de Nantes, Hopital Nord, Bd Jacques Monod, 44093 Nantes Cedex, France. Tel: +33 2165008, Fax: +33 240165024, Email: vincent.probst{at}chu-nantes.fr