Brugada syndrome: Cellular mechanisms and approaches to therapy

The Brugada Syndrome, introduced as a new clinical entity 20 years ago, has attracted great interest because of its prevalence and association with high risk of sudden death, especially in males as they enter their third and fourth decade of life. Consensus reports published in 2002 and 2005 focused on diagnostic criteria, risk stratification and approaches to therapy. More recently, the risk stratification approaches have been the subject of controversy and debate. Over 21 years have transpired since the introduction of the concept of phase 2 reentry, the mechanism believed to underlie development of arrhythmogenesis in BrS. Thus, the entity initially introduced as ST segment elevation and right bundle branch block (RBBB), which came to be known as Brugada syndrome in 1996, evolved in the experimental laboratory and in the clinic along parallel but separate tracks. While the electrocardiographic and arrhythmic manifestations of BrS are well explained by abnormal repolarization in the right ventricular outflow track (RVOT), recent data have suggested conduction impairment in the RVOT as the basis for BrS, thus generating a debate as to the basis for the pathogenicity of the syndrome. This review provides an overview of the clinical, genetic, molecular and cellular aspects of the Brugada syndrome and the various approaches to therapy.