BRUGADA

1.  Brugada Type I ECG pattern
        -The first question to answer is if he has Type I Brugada
        -Brugada Syndrome is defined as "ST-segment elevation with type 1
        morphology > or = 2 mm in > or = 1 lead among the right precordial
        leads V1, V2 positioned in the 2nd, 3rd, or 4th intercostal space
        occuring either spontaneously or after provocative drug test with
        intravenous administration of Class I antiarrhythmic drugs"
                -Priori, S et al. "HRS/EHRA/APHRS Expert Consensus Statement on
                the Diagnosis and Management of Patients with Inherited Primary
                Arrhythmia Syndromes." Heart Rhythm,Vol 10,No 12, December
                2013.
        -The 2015 ESC guidelines define Brugada Syndrome as "...diagnosed in
        patients with ST-segment elevation with type 1 morphology = 2 mm in one
        or more leads among the right precordial leads V1 and/or V2 positioned
        in the second, third, or fourth intercostal space, occurring either
        spontaneously or after provocative drug test with intravenous
        administration of sodium channel blockers (such as ajmaline,
        flecainide, procainamide or pilsicainide).
                -Priori, S et al.  "2015 ESC Guidelines for the management of
                patients with  ventricular arrhythmias and the prevention of
                sudden cardiac death."  European Heart Journal (2015) 36, 2793-
                2867
                http://secardiologia.es/images/secciones/arritmias/2793-full.pdf

        -Thus, we have established that he does infact have a spontaneous Type I
        Brugada ECG pattern

        -The next step in management is risk stratification / management:
                -He has had no VT on his zio patch
                -No reported nocturnal agonal respiration

        -Per the 2013 HRS Consensus statement, if "Spontaneous Type I ECG and hx
        of syncope judged to be caused by vent arrhytmias" if present --> then
        "ICD can be useful"

        -If he did not have syncope that was caused by a ventricular arrhythmia,
        then the consensus statement suggests to perform an EP Study
                -It should be noted that there is no concensus on the value of
                EPS in predicting outcome (Priori, S et al. "HRS/EHRA/APHRS
                Expert Consensus Statement on the Diagnosis and Management of
                Patients with Inherited Primary Arrhythmia Syndromes." Heart
                Rhythm,Vol 10,No 12, December 2013.
                -The presence of a Ventricular ERP < 200 msec has been proposed
                as a risk stratificaiton indicator