The terminal T-wave inversion in Brugada syndrome ECG is explained by the prolongation of epicardial ARI more than by the endocardial ARI when sodium current is reduced either spontaneously or by pilsicainide infusion (5). The APD restitution characteristics are important factors in determining the inducibility of VF. Patients with spontaneous AF have higher incidence of syncope and documented VF (3). However, there are still many unanswered questions. For example, suppression of sodium current in normal individuals failed to produce Brugada-type ECGs or prolong the epicardial ARI (5). The SCN5A mutation is found only in a small percentage of the patients, and the presence of SCN5A mutation does not predict the severity of the disease (4). The mechanism that resulted in the association between AF and VF remains unclear. More work is still needed to understand the mechanisms of arrhythmia in Brugada syndrome.
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