[Right bundle-branch block, the elevation of the ST segment in V1 to V3 and sudden death: the diagnostic and therapeutic approach].

In 1992, Brugada and Brugada described the "syndrome of right bundle branch block, persistent ST segment elevation and sudden death". This clinical and electrocardiographic entity, which occurs in patients with a structurally normal heart, has drawn the attention of many investigators. Nowadays, the occurrence of sudden death in otherwise asymptomatic patients with a typical ECG, and the transient normalization of the ECG in symptomatic patients, support the existence of asymptomatic and intermittent forms of this disease. The knowledge of these new forms and the modulation of the ECG pattern by administration of antiarrhythmic and autonomic drugs suggest that a functional abnormality of the electrical activity of the heart is responsible for this syndrome. The role of "M cells" in ventricular repolarization and in the occurrence of polymorphic ventricular arrhythmia suggests that these cells are the substrate for that electrical abnormality. Further studies are required to determine the appropriate therapeutic strategy for these patients. Until new information is available, the implantable cardioverter defibrillator is indicated in all symptomatic patients.