Brugada syndrome is characterized by coved ST elevation in leads V1 or V2 positioned in the second, third, or fourth intercostal space either spontaneously or induced by administration of a sodium channel blocking drug in the absence Figure 14. Prevention of SCD in patients with Brugada syndrome. Colors correspond to Class of Recommendation in Table 1. See Section 7.9.1.3 for discussion. *ICD candidacy as determined by functional status, life expec- tancy or patient preference. 1 indicates primary; ECG, electrocardiogram; EP, electrophysiological; ICD implantable cardioverter-defibrillator; SCD, sudden cardiac death; VT, ventricular tachycardia; and VF, ventricular fibrillation. Figure 15. Brugada syndrome. CLINICAL STATEMENTS AND GUIDELINES of other causes of ST elevationS7.9.1.3-24 and nega- tive T waves in the right precordial leads, and is associated with syncope or SCA due to VF, pre- dominantly in young males, although it has been reported in all age groups. The type 1 Brugada ECG with coved ST elevation in right precordial leads may be present spontaneously, during fever or vagotonic states, or after medication challenge with sodium channel blockers. QRS complex fractionation is seen in a minority of patients. Patients with spontaneous coved type ST elevation and a history of syncope or prior SCA are at the highest risk for potentially lethal VA. ICD implantation has been shown to reduce mortality in symptomatic patients with Brugada 3. Ablation of abnormal areas of epicardial late activation in the RV can suppress recur- rent VA as shown in a small number of In these reports, the spontaneous type 1 Brugada pat- tern on ECG may be eliminated in >75% of patients, and recurrences of VT/VF are markedly Experience and follow-up after ablation are limited, and an ICD for patients who have had syncope or SCA is recommended. 