Brugada syndrome is as an Inherited sodium Ion channel defect leading to loss of /or reduced sodium channel function.This specifically causes RV epicardial Imbalance of In-flowing(depolarising) and out-flowing (repolarising)current , potentially triggering ventricular arrhythmia. This happens either spontaneously or during electrical stress times which include, fever, various drugs , adverse autonomic fluxes etc. So far, we have been thinking it as primary electrical disorder with no macroscopic/ histopathologic defects.
Newer Insights are emerging
But, how is this primary electrical disease , harbor a well demarcated RV epicardial phenotypic substrate ? . . . ablation of which eliminates the VT.
Zone of probable structural defect over RV epicardium (Pink zone) amplified by infusion of Ajmaline. Note the ECG showing typical ST elvation lead V1 to V3 .(Image courtesy Carlo Pappone et all )
A recent study from Italy from the original founders (Brugada team Ref 1 ) has confirmed RF ablation of RV epicardial tissue is indeed feasible in many and should be considered in high risk Brugada syndrome. (Then should we suggest , ICD is no longer a choice in Brugada ?)
MRI findings in Brugada has shown some structural defects .(Ref 3,5) .It seems Brugada is an Inherited electrical cardiomyopathy with a structural defect. (The overlap between ARVD and Brugada syndrome appear more real than we thought before ! (Ref 7 )
Final message
Still , Brugada is more of a electrical disorder, but soon we may refer it as structural heart disease.
Reference
Dr.S.Venkatesan MD 
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