What is the treatment for Brugada (Brugada syndrome) heart rhythm?

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Treatment for Brugada Syndrome Heart Rhythm

The treatment for Brugada syndrome is primarily based on risk stratification, with implantable cardioverter-defibrillator (ICD) being the cornerstone therapy for high-risk patients, while quinidine or catheter ablation are recommended for those experiencing recurrent ICD shocks or those who are not candidates for an ICD. 1

Risk Stratification and Treatment Algorithm

Asymptomatic Patients

  • For asymptomatic patients with only inducible type 1 Brugada electrocardiographic pattern, observation without therapy is recommended 1
  • In asymptomatic patients with a spontaneous type 1 Brugada electrocardiographic pattern, an electrophysiological study with programmed ventricular stimulation using single and double extrastimuli may be considered for further risk stratification 1
  • Lifestyle modifications are recommended for all patients with Brugada syndrome, including:
    • Avoidance of drugs that may induce ST-segment elevation in right precordial leads 1
    • Avoidance of excessive alcohol intake and large meals 1
    • Prompt treatment of any fever with antipyretic drugs 1

Symptomatic Patients

  • For patients with Brugada syndrome with spontaneous type 1 Brugada electrocardiographic pattern and:
    • Cardiac arrest, sustained ventricular arrhythmia (VA), or recent history of syncope presumed due to VA → ICD implantation is recommended if meaningful survival of greater than 1 year is expected 1
    • For patients experiencing recurrent ICD shocks for polymorphic ventricular tachycardia (VT) → intensification of therapy with quinidine or catheter ablation is recommended 1
    • For patients with symptomatic VA who either are not candidates for or decline an ICD → quinidine or catheter ablation is recommended 1

Special Considerations

Diagnostic Testing

  • In patients with suspected Brugada syndrome without a spontaneous type 1 Brugada electrocardiographic pattern, a pharmacological challenge using a sodium channel blocker (such as flecainide, ajmaline, procainamide) can be useful for diagnosis 1

Genetic Testing

  • In patients with suspected or established Brugada syndrome, genetic counseling and genetic testing may be useful to facilitate cascade screening of relatives 1
  • However, genetic testing results currently do not influence prognosis or treatment decisions 1

Efficacy of Treatments

Implantable Cardioverter-Defibrillator (ICD)

  • ICD is the only treatment proven to effectively prevent sudden cardiac death in high-risk Brugada syndrome patients 1
  • The decision to implant an ICD must balance the risk of sudden death against device complications and impact on quality of life 2

Pharmacological Therapy

  • Quinidine has been shown to reduce ventricular fibrillation inducibility during programmed ventricular stimulation 1
  • It is particularly useful in:
    • Patients experiencing recurrent ICD shocks 1
    • Patients who are not candidates for or refuse ICD implantation 1
    • Patients who require treatment for supraventricular arrhythmias 1

Catheter Ablation

  • Epicardial catheter ablation over the anterior right ventricular outflow tract may prevent electrical storms in patients with recurring episodes 1
  • This approach is recommended for patients with history of electrical storms or repeated appropriate ICD shocks 1

Prognosis Based on Risk Factors

  • The annual incidence of arrhythmic events in Brugada syndrome varies significantly based on risk factors:
    • 13.5% per year in patients with a history of sudden cardiac arrest 1
    • 3.2% per year in patients with syncope 1
    • 1% per year in asymptomatic patients 1

Common Pitfalls and Caveats

  • ECG changes in Brugada syndrome are often intermittent and may be provoked by fever or sodium channel blocker challenge 3
  • Spontaneous type 1 Brugada pattern carries a worse prognosis than drug-induced pattern 1
  • The role of electrophysiological testing in risk stratification remains controversial, with studies showing variable predictive value 1
  • Brugada syndrome is more common in males and those of Southeast Asian descent, but patient sex does not appear to impact prognosis 3
  • Fever can acutely predispose to cardiac arrest in Brugada syndrome patients, making prompt treatment of fever essential 1

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Research

Brugada Syndrome.

JACC. Clinical electrophysiology, 2022

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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