BRUGADA

Right ventricular variant of J wave syndrome.
The region most affected by the disease is the anterior right ventricular outflow tract(RVOT). The patients display J- point and ST-segment elevation in the right precordial leads.

EARLY REPOLARIZATION

Distinct J-wave or J-point elevation, notch, or slur of the terminal part of the QRS, and ST-segment elevation in the lateral (type I), infero-lateral (type II), or infero-lateral plus anterior or right ventricular leads (type III).

Antzelevich et al. Heart Rhythm 2015.

The MECHANISMS of J-wave Syndrome have long been a matter of debate.

DELAYED DEPOLARIZATION

Nademanee et al. Circulation 2011.

EARLY REPOLARIZATION

Szel & Antzelevich. JACC 2011.

PREVALENCE & ARRHYTHMIC RISK ASSOCIATED WITH j-WAVE

2016 J-Wave Syndrome Expert Consensus

Only TYPE 1 ST elevation is diagnostic for BRUGADA SYNDROME

characterized by ST-segment elevation ≥2 mm (0.2mV) in ≥1 right precordial leads (V1–V3) positioned in the 4th, 3rd, or 2nd intercostal space.

2016 J-Wave Syndrome Expert Consensus

Risk of recurrent VF is high in those with history of aborted sudden cardiac arrest.

Sacher et al. Circulation 2013.

Risk of recurrent VF after SCA is 25% at 1 year and 48% at 5 years.
Risk of recurrent VF after syncope is approximately 3 times higher than the risk of asymptomatic group.

NEGATIVE EP STUDY is NOT sufficient to identify low-risk individuals.

In individuals with high or low risk clinical features, EP study provided limited incremental prognostic value.

In intermediate risk group, inducible EP study would increase risk of malignant arrhythmia to 1.7%/year and an ICD would be recommended.
If, however, the patient is non-inducible, the risk would be lower, 0.78%, but not sufficiently low enough.

Daoud EG. Circulation 2016.

J-point elevation with UPSLOPING ST-segment is BENIGN.

Early Repolarization Pattern that is potentially arrhythmogenic was defined in the presence of
1. an end-QRS notch or slur on the downslope of a prominent R wave. The notch/slur should be entirely above the baseline.
2. A peak of the J wave (notched or slurred) ≥0.1 mV in 2 or more contiguous leads of the 12-lead ECG, excluding leads V1 to V3 (to avoid confusion with Brugada Syndrome diagnosis).
3. QRS duration <120 milliseconds.

Priori et al. Card Electrophysiol Clin 2018. & Junttila et al. Eur Heart J 2012.

CATHETER ABLATION continued to evolve as both definitive and palliative treatment for J-wave syndrome.

Late depolarization fragmented EGM due to microstructural myocardial alterations is the target for catheter ablation.

Haıssaguerre et al. Heart Rhythm 2019.

Resolution of Brugada pattern after catheter ablation.

Nademanee et al. Circulation 2011.