From the Guidelines
Brugada syndrome patients with spontaneous type 1 Brugada electrocardiographic pattern and cardiac arrest, sustained VA or a recent history of syncope presumed due to VA, should be recommended for an ICD if meaningful survival of greater than 1 year is expected. This recommendation is based on the 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death 1. The guideline suggests that an ICD is recommended for patients with Brugada syndrome who have a high risk of sudden cardiac death, such as those with a history of cardiac arrest or syncope.
Diagnosis and Risk Stratification
The diagnosis of Brugada syndrome is established in the presence of spontaneous or induced ST segment elevation in leads V1-V3 with/without right bundle branch block 1. Risk stratification is crucial, with factors like previous cardiac arrest, spontaneous ECG pattern, and family history of sudden death considered.
Treatment Options
Treatment options for Brugada syndrome include:
- Implantation of a cardioverter-defibrillator (ICD) for high-risk patients to prevent sudden death
- Medications like quinidine may be used in some cases
- Catheter ablation may be recommended for patients with recurrent ICD shocks for polymorphic VT
- Genetic testing can identify mutations in the SCN5A gene and help with family screening
Lifestyle Modifications
Patients with Brugada syndrome should avoid:
- Excessive alcohol
- Fever-inducing activities
- Certain medications that may trigger arrhythmias, such as certain antiarrhythmics, tricyclic antidepressants, and some anesthetics.
Overall, the management of Brugada syndrome requires a comprehensive approach, including diagnosis, risk stratification, treatment, and lifestyle modifications to reduce the risk of sudden cardiac death.
From the Research
Definition and Treatment of Brugada Syndrome
- Brugada syndrome (BrS) is an inherited disease characterized by an increased risk of sudden cardiac death (SCD) 2.
- Therapeutic options in symptomatic patients are limited to implantable cardioverter defibrillator (ICD) and quinidine, but catheter ablation of the right ventricular outflow tract (RVOT) offers a potential cure 2.
Implantable Cardioverter-Defibrillator (ICD) Therapy
- ICD therapy is effective for primary and secondary prevention of SCD in BrS 3, 4, 5.
- Appropriate shocks occur more frequently in BrS patients presenting with VT/VF, but also occur in asymptomatic patients 3, 4, 5.
- ICD therapy is associated with high rates of inappropriate shocks and device-related complications 3, 4, 5.
Catheter Ablation
- Catheter ablation has emerged as a promising treatment to prevent ventricular fibrillation (VF) in Brugada syndrome 2, 6.
- Epicardial substrate ablation significantly reduces VF recurrence in symptomatic BrS patients with ICDs and appears safe 6.
- Ablation targeted arrhythmogenic areas identified through electroanatomical mapping, predominantly at the right ventricular epicardium 6.
Risk Stratification and Predictors of Appropriate Shock Delivery
- Type 1 Brugada pattern is an independent predictor of appropriate shock delivery 3.
- The presence of other arrhythmia is predictive for both appropriate and inappropriate ICD shock delivery under multivariate Cox regression analysis 3.
- Aborted sudden cardiac death and VA inducibility on electrophysiologic studies are independent predictors of appropriate shock occurrence 4.
- Type 1 electrocardiogram with syncope and secondary prevention indication are significant predictors of appropriate therapy 5.