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The Brugada syndrome : advances and controversies

dinsdag, 14 december, 2010 - 17:00
Campus: Brussels Health Campus
Faculteit: Medicine and Pharmacy
auditorium P. Brouwer
Andrea Sarkozy
doctoraatsverdediging

The Brugada syndrome is a familiar form of ST
elevation in the right precordial leads leading to
an increased risk of sudden death. In order to
avoid the overdiagnosis of healthy individuals
with the syndrome but in the meantime to
identify young patients at risk of dying suddenly,
two consensus reports proposed diagnostic
criteria. However, inconsistencies remained. We
report that the presence of coved type ST
elevation in one right precordial lead is sufficient
for the diagnosis. We describe that the diagnostic
ECG abnormalities may appear exclusively in the
inferior-lateral leads. We report a close
association between the early repolarization
syndrome and Brugada syndrome. We document
in a study of our ICD population that the
variability of the ECG pattern is much higher than
previously thought. We show that the consensus
clinical diagnostic criteria are neither useful nor
necessary for the diagnosis. These studies show
that the consensus diagnostic criteria, which are
currently the gold standard in the diagnosis of
Brugada syndrome, are outdated. In the last
years the area of interest became risk
stratification. We report important gender
differences in the clinical manifestation and
prognosis of the syndrome. We show convincingly
that family history of sudden death is not a
predictor of risk unless multiple sudden deaths at
a young age in close relatives occur. The only
proven treatment for the prevention of sudden
death is the implantable cardioverter defibrillator
(ICD). We report that patients without previous
cardiac arrest can effectively be saved from
sudden death with ICD therapy, however, at the
cost of a high complication rate.