Synopsis
Recognise a diagnostic type 1 Brugada pattern and other inherited channelopathy clues, manage fever and malignant ventricular arrhythmia, and route patients and families to inherited-cardiac-condition expertise.
- A type 1 Brugada ECG is coved ST elevation over 0.2 mV followed by T-wave inversion in at least one V1–V2 lead placed in the second, third or fourth intercostal space.
- A spontaneous type 1 pattern is diagnostic in the right setting; fever- or sodium-channel-blocker-induced type 1 generally needs compatible clinical features for a Brugada syndrome diagnosis.
- Type 2 saddleback appearances are not diagnostic alone and should not trigger an ICD without expert phenotyping.
Key red flags
Unexplained syncope at rest, nocturnal agonal breathing, documented polymorphic VT/VF or cardiac arrest—especially during fever—raises immediate risk concern.
Investigation priorities
Identify spontaneous type 1 Brugada morphology and measure PR, QRS and QTc.
Management branches
A right-precordial Brugada-like pattern or compatible syncope/family history is found.
- Check symptoms, family history, fever, medications/recreational drugs and reversible phenocopies; repeat correctly placed standard and high-right-precordial ECGs.
- If spontaneous type 1 or arrhythmic symptoms are present, obtain urgent electrophysiology/inherited-cardiac review and restrict driving according to specialist advice.
Key medicines
Paracetamol1 g orally every 4 hours as required for fever, no more than four doses (4 g) in 24 hours; do not continue beyond 3 days without medical review.
Isoprenaline infusionBrugada electrical storm is a specialist off-label exception. A current UK SmPC infusion starts at 0.01 microgram/kg/min IV and allows 0.01 microgram/kg/min increments to 0.15 microgram/kg/min; the electrophysiology/critical-care team titrates to arrhythmia suppression under continuous ECG and BP monitoring.