Clinical diagnosis and risk stratification in patients with Brugada syndrome.

In patients with Brugada syndrome (BRS), especially those who are asymptomatic, preclinical diagnosis and risk stratification are vital to the prevention of the fatal ventricular arrhythmias. The initial optimism that a diagnosis of BRS could be made simply on the basis of distinct electrocardiographic (ECG) changes (see the following text) has been tempered, both by a high incidence of false-positive and false-negative cases related to “waxing” and “waning” ECG signature (1,2) and by drugor disease-induced ECG abnormalities resembling those in BRS (3–5). Thus, the need for additional diagnostic tools and strict clinical criteria for diagnosing of BRS has become evident. In their well documented retrospective study published elsewhere in this issue of the Journal, Dr. Ikeda et al. (6) have presented evidence that signal-averaged electrocardiography may be useful for risk stratification of patients with ECG evidence of BRS. In a study population of BRS