Which of the following is the characteristic electrocardiographic finding in Brugada syndrome?

Explanation

## Brugada Syndrome: ECG Hallmark **Key Point:** Brugada syndrome is characterized by a distinctive Type 1 Brugada pattern on ECG, which consists of a **coved ST segment elevation of ≥2 mm in leads V1–V2, followed by a negative T wave**. This pattern reflects abnormal repolarization due to loss-of-function mutations in the SCN5A gene (sodium channel). ### Three ECG Patterns of Brugada Syndrome | Pattern | ST Elevation | T Wave | Clinical Significance | |---------|--------------|--------|----------------------| | **Type 1** | Coved, ≥2 mm in V1–V2 | Negative | Diagnostic; highest risk | | **Type 2** | Saddleback, 1–2 mm in V1–V2 | Positive then negative | Intermediate risk | | **Type 3** | Saddleback, <1 mm in V1–V2 | Positive | Lower risk; may progress | **High-Yield:** Only Type 1 pattern is diagnostic of Brugada syndrome. Types 2 and 3 require repeat ECGs or provocative testing (sodium channel blockers like ajmaline or flecainide) to confirm diagnosis. ### Clinical Pearl **Brugada syndrome presents with:** - Sudden nocturnal ischemic dyspnea (SNID) or syncope during sleep - Risk of sudden cardiac death (SCD) in young, apparently healthy individuals - More common in males and Southeast Asian populations - Fever can unmask or worsen the ECG pattern **Mnemonic:** **BRUGADA** = **BR**azil/**BR**own race, **U**nmasked by **GA**stric **DA**mage (fever) ### Differential from Other Arrhythmia Syndromes - ~~Long QT syndrome~~ → prolonged QT interval, not coved ST elevation - ~~Wolff–Parkinson–White (WPW)~~ → delta wave + short PR interval, not coved ST - ~~Early repolarization~~ → benign variant; no negative T wave in V1–V2