| Summary: | Type 1 ST-segment elevation is diagnostic of Brugada syndrome and its presence may be associated with a high risk of arrhythmic events. However, similar changes on electrocardiogram (ECG) are observed in various normal and abnormal conditions. A type 1 ECG can also be unmasked by administration of sodium channel blockers in equivocal or suspected cases of Brugada syndrome, and this drug challenge test is frequently used in the diagnosis of symptomatic patients showing non-type 1 ECG patterns. The presence of a transient spontaneous type 1 ECG rather than a drug-induced type I ECG is an important sign for risk prediction of arrhythmia events, even in asymptomatic patients. In asymptomatic individuals, multiple and repeated ECG recordings rather than drug testing are recommended for detecting the transient appearance of a spontaneous type 1 ECG, which may indicate the future development of arrhythmic events. There is little doubt that ECG interpretation, including diagnostic criteria and differential diagnosis, constitutes the hallmark of Brugada syndrome.
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