ECG patterns of Brugada syndrome in leads V1-V2

(A) This typical coved pattern present in V1-V2 shows the following:

At the end of QRS, an ascending and quick slope with a high take-off ≥2 mm followed by concave or rectilinear downsloping ST. There are few cases of coved pattern with a high take-off between 1 and 2 mm.
There is no clear r' wave.
The high take-off often does not correspond with the J point.
At 40 milliseconds of high take-off, the decrease in amplitude of ST is ≤4 mm. In RBBB and athletes, it is much higher.
ST at high take-off N ST at 40 milliseconds N ST at 80 milliseconds.
ST is followed by negative and symmetric T wave.
The duration of QRS is longer than in RBBB, and there is a mismatch between V1 and V6.

(B) This typical saddle-back pattern present in V1-V2 shows the following:

High take-off of r' (that often does not coincide with J point) ≥2 mm.
Descending arm of r' coincides with beginning of ST (often is not well seen).
Minimum ST ascent ≥0.5 mm.
ST is followed by positive T wave in V2 (T peak N ST minimum N 0) and of variable morphology in V1.
The characteristics of triangle formed by r' allow to define different criteria useful for diagnosis.
- β angle.
- Duration of the base of the triangle of r' at 5 mm from the high take-off greater than 3.5 mm.
The duration of QRS is longer in BrP type 2 than in other cases with r' in V1, and there is a mismatch between V1 and V6.

RBBB: right bundle branch block.

Reproduced from: Bayés de Luna A, Brugada J, Baranchuk A, et al. Current electrocardiographic criteria for diagnosis of Brugada pattern: a consensus report. J Electrocardiol 2012; 45:433. Illustration used with the permission of Elsevier Inc. All rights reserved.

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ECG patterns of Brugada syndrome in leads V1-V2