From the Guidelines
Brugada syndrome symptoms include fainting, irregular heartbeats, and sudden cardiac arrest, which often occurs during sleep or rest. Many people with Brugada syndrome remain asymptomatic until a cardiac event occurs. The condition may cause palpitations, seizures, or difficulty breathing, particularly at night. Some patients experience symptoms during fever or when taking certain medications that affect heart rhythm. Brugada syndrome is caused by genetic mutations affecting heart electrical activity, specifically sodium channels in heart cells. The characteristic ECG pattern shows ST-segment elevation in the right precordial leads (V1-V3) 1. This condition is more common in men and people of Asian descent, particularly those from Southeast Asia. If you experience fainting episodes or have a family history of sudden cardiac death, seek immediate medical evaluation, as early diagnosis can be lifesaving.
Key Symptoms
- Fainting
- Irregular heartbeats
- Sudden cardiac arrest
- Palpitations
- Seizures
- Difficulty breathing
Diagnosis and Treatment
Treatment typically involves implantable cardioverter-defibrillators (ICDs) for high-risk patients, avoiding trigger medications, and promptly treating fevers 1. The yield of genetic testing in phenotype positive patients is approximately 20% to 30% in Brugada syndrome, with SCN5A variants accounting for most of this subset of genotype positive Brugada syndrome 1.
Important Considerations
- Brugada syndrome is inherited as a dominant trait and shows age- and sex-related penetrance: clinical manifestations of the disease are more frequent in adults and they are eightfold more frequent in men than in women 1.
- Fever, excessive alcohol intake and large meals are triggers that unmask a type I ECG pattern and predispose to VF 1.
- ICD implantation is recommended in patients with a diagnosis of Brugada syndrome who are survivors of an aborted cardiac arrest and/or have documented spontaneous sustained VT 1.
From the Research
Symptoms of Brugada Syndrome
The symptoms of Brugada syndrome include:
- Syncope (fainting) 2, 3, 4
- Cardiac arrest 2, 5, 4, 6
- Sudden cardiac death 2, 5, 4, 6
- Documented ventricular tachyarrhythmia 3
- Arrhythmic syncope 4
Risk Factors and Diagnosis
Brugada syndrome is characterized by:
- A coved-type ST-segment elevation of at least 2 mm followed by a negative T wave in the right precordial leads on an electrocardiogram (ECG) 2, 6
- Intermittent ECG changes that may be provoked by fever or sodium channel blocker challenge 2
- A family history of Brugada syndrome or sudden death 4
- The presence of an epicardial arrhythmic substrate within the right ventricular outflow tract 2
Management and Treatment
Current management of Brugada syndrome involves:
- Conservative measures in asymptomatic patients, including fever management and drug avoidance 2
- Implantable cardioverter-defibrillator insertion in symptomatic patients 2, 5, 6
- Quinidine and epicardial ablation for patients with recurrent arrhythmia 2
- Risk stratification to identify patients at increased risk of sudden cardiac death 2, 4