Shanghai Score System (Brugada Syndrome Diagnosis)
The SHANGHAI SCORE SYSTEM for Brugada syndrome (Antzelevitch and colleagues 2016, endorsed by the international rhythm societies), maximum 9.
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Category I, the HIGHEST-scoring ECG finding
- Spontaneous type 1 Brugada ECG pattern at nominal or high leads
- Category II, the SINGLE HIGHEST-scoring clinical item
- Suspected arrhythmic syncope
- Category III, the SINGLE HIGHEST-scoring family item
- No qualifying family history
- Category IV, a probable pathogenic mutation in a Brugada susceptibility gene
- No
Result: 5.5
The tool opens with these values already filled in. Replace them with your own.
What the result means
- Gate
- AT LEAST ONE ECG FINDING IS REQUIRED. 5.5 points from the other categories is still NON-DIAGNOSTIC.
- Maxima
- Within each category only the SINGLE HIGHEST item counts. Categories do not sum within themselves.
- 3.5 or more
- Probable and/or definite Brugada syndrome. Never report this as "definite" alone.
- 2 to 3
- Possible Brugada syndrome.
- Under 2
- Non-diagnostic.
- Age gate
- The atrial fibrillation item scores 0.5 ONLY under 30 years; at 30 and above it does not exist.
- Family
- SECOND-degree relatives count; the sudden-death item requires a NEGATIVE AUTOPSY.
- Genetics
- A probable pathogenic mutation is deliberately de-weighted to 0.5 and cannot open the ECG gate.
- Scope
- Diagnostic, NOT risk stratification. Does not decide on a defibrillator. Not the Brugada VT algorithm.
What you enter
- Category I, the HIGHEST-scoring ECG finding.
- Category II, the SINGLE HIGHEST-scoring clinical item - they do not add
- Category III, the SINGLE HIGHEST-scoring family item - they do not add
- Category IV, a probable pathogenic mutation in a Brugada susceptibility gene.
- Age.
Full field descriptions
- Category I, the HIGHEST-scoring ECG finding. THIS IS A GATE: "none" makes the result non-diagnostic regardless of the total [none = No qualifying ECG finding (0); spontaneous-type1 = Spontaneous type 1 Brugada ECG pattern at nominal or high leads (3.5); fever-type1 = Fever-induced type 1 Brugada ECG pattern at nominal or high leads (3); type2-3-converts = Type 2 or 3 Brugada ECG pattern that converts with provocative drug challenge (2)]
- Category II, the SINGLE HIGHEST-scoring clinical item - they do not add [none = No qualifying clinical history (0); arrest-vf-vt = Unexplained cardiac arrest, or documented ventricular fibrillation or polymorphic ventricular tachycardia (3); nocturnal-agonal = Nocturnal agonal respirations (2); arrhythmic-syncope = Suspected arrhythmic syncope (2); unclear-syncope = Syncope of unclear mechanism or etiology (1); af-under-30 = Atrial flutter or fibrillation without alternative etiology, ONLY under 30 years of age (0.5)]
- Category III, the SINGLE HIGHEST-scoring family item - they do not add [none = No qualifying family history (0); definite-brs-relative = First- or SECOND-degree relative with definite Brugada syndrome (2); suspicious-scd = Suspicious sudden cardiac death in a relative (fever, nocturnal, or Brugada-aggravating drugs) (1); unexplained-scd-negative-autopsy = Unexplained sudden cardiac death under 45 in a first- or second-degree relative WITH A NEGATIVE AUTOPSY (0.5)]
- Category IV, a probable pathogenic mutation in a Brugada susceptibility gene. 0.5 point, deliberately de-weighted, and it cannot open the ECG gate.
- Age. Required ONLY when the atrial fibrillation clinical item is selected, because that item scores only under 30 years and contributes nothing at or above it.
How this is calculated
Antzelevitch C, Yan GX, Ackerman MJ, et al. J-Wave syndromes expert consensus conference report: emerging concepts and gaps in knowledge. Europace. 2017;19(4):665-694 (Shanghai Score System). Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.