Brugada syndrome is characterised by ST elevation in leads V1–V3. The spontaneous (Type 1) Brugada ECG pattern shows which SPECIFIC morphology?

• A Saddleback ST elevation ≥2 mm with a positive or biphasic T wave
• B J-point elevation with flat or positive ST segment and no T-wave inversion
• C ST elevation with peaked, hyperacute T waves mimicking anterior STEMI
• D Coved-type ST elevation (downsloping ST ≥2 mm) with a terminal negative T wave ✓

Explanation

Brugada Type 1 ECG (diagnostic pattern): coved-type with ST elevation ≥2 mm in V1–V3 with a downward slope and terminal negative T wave — like a 'cove' shape. Type 2 (saddleback pattern) has elevated ST >2 mm with a concave 'saddle' and positive/biphasic T wave — this is provocative but not diagnostic without pharmacologic unmasking (ajmaline, flecainide, procainamide). Type 3 (saddleback <2 mm ST elevation) was removed from the 2016 revised criteria. Only Type 1 (spontaneous or drug-unmasked) meets diagnostic criteria.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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