EMS Registry ReadyExample 1 · lead V1 · 6 seconds
- Rate
- 92/min9 QRS complexes in 6 seconds × 10 = 90/min
- Rhythm
- Regular
- P waves
- Sinus: upright in II, biphasic in V1, one before every QRS
- P to QRS
- 1:1, a P before every QRS
- PR
- 0.19 s
- QRS
- 0.11 s, narrow
Brugada pattern, type 1 (coved) on an ECG strip
In V1-V2, the ST rises over 2 mm at the J point and falls in a coved, convex curve straight into an inverted T wave.
What to look for
A sodium channel disorder of the right ventricular outflow tract, seen in V1-V2, the leads over it. Type 1 is the only diagnostic pattern. It has a high take-off over 2 mm at the J point, then a coved ST that falls in a convex curve straight into an inverted T, with no flat segment between. Type 2 (saddleback) has the same take-off, but the ST stays elevated (over 1 mm) and rises into an upright or biphasic T. On its own, it's an ECG pattern. Brugada syndrome is that pattern plus a clinical event (syncope, VF or polymorphic VT, a family history of sudden death). Moving V1-V2 up one or two rib spaces brings it out.
Examples
Each strip is 6 seconds of lead V1, drawn to scale (25 mm a second, 10 mm a millivolt), so you can count boxes the way you would on paper. Each one is a different example, measured below it.
Example 2 · lead V1 · 6 seconds
- Rate
- 83/min9 QRS complexes in 6 seconds × 10 = 90/min
- Rhythm
- Regular
- P waves
- Sinus: upright in II, biphasic in V1, one before every QRS
- P to QRS
- 1:1, a P before every QRS
- PR
- 0.12 s
- QRS
- 0.09 s, narrow
Example 3 · lead V1 · 6 seconds
- Rate
- 67/min7 QRS complexes in 6 seconds × 10 = 70/min
- Rhythm
- Regular
- P waves
- Sinus: upright in II, biphasic in V1, one before every QRS
- P to QRS
- 1:1, a P before every QRS
- PR
- 0.14 s
- QRS
- 0.09 s, narrow
Don't confuse it with
- Sinus rhythm with right bundle branch block
A QRS of 0.12 s or more with rSR' (an 'M') in V1-V3 and a wide, slurred S in I, aVL, V5 and V6.
- Anteroseptal STEMI
ST elevation across V1-V4, from an occluded left anterior descending artery.
- Normal sinus rhythm
Regular at 60-100/min, an upright P before every QRS, a PR of 0.12-0.20 s and a narrow QRS.
Want a new strip every time? The ECG Drill in the app draws a fresh, measured example on every try and steers you toward the rhythms you miss. It's part of the Paramedic level, and you can try 5 strips a day free.
Try the ECG Drill