Brugada syndrome was described 10 years ago. It is a syndrome of sudden cardiac death associated with partial right bundle branch block and ST segment elevation in the right precordial leads V1-V3 on the resting ECG. Those affected have structurally normal hearts (as demonstrated by standard techniques) but they have a mortality rate of 10% a year, whether they are symptomatic or asymptomatic. It is thought to be primarily a disease of cardiac conduction and has been linked to abnormalities in the sodium channel (SCN5A). Differential diagnoses include arrhythmogenic right ventricular dysplasia, idiopathic ventricular fibrillation and polymorphic ventricular tachycardia. Brugada et al. suggest that the Brugada shift pattern on 12-lead ECG is a specific marker for those at risk of sudden death. They recommend that symptomatic individuals be protected with an implantable cardiac defibrillator. Asymptomatic individuals remain a diagnostic dilemma.