This ECG was obtained in a 55-year-old Vietnamese male with a febrile illness whose telemetry was showing asymptomatic runs of ventricular tachycardia just prior to this tracing. There is a sinus rhythm at 95 BPM with ST elevation in V1, V2, and an incomplete right bundle branch block (iRBBB). This is a classic example of Brugada, type 1, a rare genetic mutation that increases risk of ventricular arrhythmia and sudden cardiac death. Brugada is characterized by ST elevation in V1, V2 and sometimes V3, with an iRBBB conduction defect. The different types of Brugada are depicted in the “i” link on the scoresheet of O’Keefe ECG. The pathognomonic Brugada pattern is often discovered by routine ECG in an asymptomatic individual. People with Asian ancestry are at increased risk for this syndrome. Clinical manifestations include syncope and cardiac arrest—typically occurring during sleep. Atrial fibrillation is documented in ≈20% of Brugada patients. As in this case, fever often triggers or exacerbates the clinical manifestations of Brugada. Scoring for the iRBBB and non-specific ST-T abnormalities is optional once Brugada has been scored because these are inherent ECG features of this syndrome.

Correct Answers:

• Sinus rhythm +2.
• Brugada syndrome +7.
• Right bundle branch block, incomplete (iRBBB) 0.
• Nonspecific ST-T changes 0.