Brugada Syndrome Treatment and Management

Risk Stratification and Treatment

The American College of Cardiology recommends implantable cardioverter-defibrillator (ICD) as the cornerstone therapy for high-risk Brugada syndrome patients, while quinidine or catheter ablation are recommended for those experiencing recurrent ICD shocks or those who are not candidates for an ICD 1, 2
For asymptomatic patients with only inducible type 1 Brugada electrocardiographic pattern, observation without therapy is recommended 1, 2
The European Heart Journal suggests that lifestyle modifications, including avoidance of drugs that may induce ST-segment elevation, avoidance of excessive alcohol intake and large meals, and prompt treatment of any fever with antipyretic drugs, are recommended for all patients with Brugada syndrome 4

The American College of Cardiology recommends that a pharmacological challenge using a sodium channel blocker can be useful for diagnosis in patients with suspected Brugada syndrome without a spontaneous type 1 Brugada electrocardiographic pattern 1, 2, 4
Genetic counseling and genetic testing may be useful to facilitate cascade screening of relatives in patients with suspected or established Brugada syndrome, as suggested by the American College of Cardiology 1, 2

The European Heart Journal states that ICD is the only treatment proven to effectively prevent sudden cardiac death in high-risk Brugada syndrome patients 4, 5
Quinidine has been shown to reduce ventricular fibrillation inducibility during programmed ventricular stimulation, and is particularly useful in patients experiencing recurrent ICD shocks, those who are not candidates for or refuse ICD implantation, and those who require treatment for supraventricular arrhythmias, as reported by the European Heart Journal 4, 5
Epicardial catheter ablation over the anterior right ventricular outflow tract may prevent electrical storms in patients with recurring episodes, as recommended by the European Heart Journal 4, 5
The annual incidence of arrhythmic events in Brugada syndrome varies significantly based on risk factors, with 13.5% per year in patients with a history of sudden cardiac arrest, 3.2% per year in patients with syncope, and 1% per year in asymptomatic patients, according to the European Heart Journal 5, 6

Spontaneous type 1 Brugada pattern carries a worse prognosis than drug-induced pattern, as stated by Circulation 7
Fever can acutely predispose to cardiac arrest in Brugada syndrome patients, making prompt treatment of fever essential, as reported by the European Heart Journal and Circulation 4, 7