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rugada syndrome (BS) is a distinct form of idiopathic ventricular fibrillation (VF) characterized by a unique ECG pattern consisting of ST elevation in the anterior precordial leads with/without right bundle branch blocklike morphology.1 It is generally accepted that patients with the type 1 ECG pattern (coved type) and with ventricular tachyarrhythmias (symptomatic BS patients) must receive an implantable cardioverter defibrillator to prevent a second VF attack.2 However, in those without syncope, family history or documented VF (asymptomatic BS patients), the best strategy is controversial because the prevalence of Brugada-type ECG change by daily medical check-ups has been reported to be approximately 0.1–1.0% in healthy subjects, but their prognosis is good compared with that of symptomatic patients.3 However, some asymptomatic BS patients occasionally become symptomatic and sudden cardiac death can occur with the first VF attack. Therefore, a marker that can differentiate high-risk asymptomatic patients from low-risk asymptomatic patients is needed. To date, several invasive and noninvasive parameters have been proposed for identification of patients at risk of VF, including spontaneous type 1 ST elevation,3 characteristics of the S wave,4 presence of late potentials,5 coexisting atrial fibrillation,6 augmented ST elevation after exercise,7 fragmented QRS wave,8 early repolarization pattern in the inferior/lateral leads,3 third intercostal ECG9,10 and inducibility of VF using programmed electrical stimulation, but the usefulness of these indexes remains controversial.

ECG Marker of High-Risk in Asymptomatic Patients With Brugada Syndrome