Brugada ECG patterns in athletes

- The Type 1 Brugada pattern is diagnostic of Brugada syndrome and while rare is the pattern of most concern.
- There are many causes of Brugada-like ECGs including normal variant, early repolarization, and arrhythmogenic right ventricular cardiomyopathy.
- Multiple criteria have been described to help distinguish a Type 1 or 2 Brugada ECG from a Brugada-like ECG.
- Proper precordial ECG lead placement at the 4th intercostal space is paramount: high lead ECGs with V1 and V2 purposely in the 2nd intercostal space may aid in the evaluation.

Brugada syndrome is responsible for up to 4% of all sudden cardiac deaths worldwide and up to 20% of sudden cardiac deaths in patients with structurally normal hearts. Heterogeneity of repolarization and depolarization, particularly over the right ventricle and the outflow tract, is responsible for the arrhythmogenic substrate. The coved Type I ECG pattern is considered diagnostic of the syndrome but its prevalence is very low. Distinguishing between a saddle back Type 2 Brugada pattern and one of many “Brugada-like” patterns presents challenges especially in athletes. A number of criteria have been proposed to assess Brugada ECG patterns. Proper precordial ECG lead placement is paramount. This paper reviews Brugada syndrome, Brugada ECG patterns, and recently proposed criteria. Recommendations for evaluating a Brugada ECG pattern are provided.