The Brugada syndrome

Fifteen years ago in this Journal, Brugada and Brugada reported a new syndrome with ST-segment elevation in ECG leads V1 to V3, right bundle branch appearance during sinus rhythm, and a high incidence of ventricular fibrillation (VF) and sudden cardiac death. There were 8 patients (6 males and 2 females) in that original report. Patient #7, an 8-year-old girl, was the only 1 with a history of paroxysmal atrial fibrillation (AF). The paroxysmal AF occurred soon after birth, and the first episode of syncope occurred at the age of 8 years. She was a subject in another case report 12 years later because of multiple documented episodes of VFs induced by short-coupled premature ventricular contractions. Programmed stimulation induced nonsustained polymorphic ventricular tachycardia in 3 patients at baseline and during isoproterenol infusion. In 4 patients, including Patient #7, the same programmed stimulation induced VF. In this issue of the Journal, 3 articles provided new insights into the characteristic T-wave changes in Brugada syndrome, the prevalence of AF, and the mechanisms that determine the inducibility of VF during electrophysiological studies. These studies have significantly advanced the understanding of Brugada syndrome.