Before Diagnosis

What is Brugada Syndrome?

Brugada Syndrome is a condition caused by a defect in the cardiac cell channels, potentially leading to irregular heart rhythms and, in rare cases, cardiac arrest or sudden death.

Is Brugada Syndrome inherited or acquired?

• Brugada Syndrome can be hereditary, passed within families, though certain triggers may increase the likelihood of symptoms or ECG findings.
• It may also appear for the first time in an individual without being inherited from the parents.

What triggers Brugada Syndrome?

• Fever (commonly due to infections or the flu).
• Certain medications that interact with Brugada Syndrome (listed at the bottom of the document).
• Use of cocaine, cannabis, or alcohol.

What are the symptoms of Brugada Syndrome?

• The majority of individuals with Brugada Syndrome are asymptomatic, with the condition discovered incidentally through an ECG (e.g., during hospital visits for other reasons).
• A small percentage of patients experience heart palpitations, fainting, or seizures.
• In very rare cases, sudden cardiac arrest may be the first symptom.
• Brugada Syndrome does not cause chest pain or shortness of breath.

Does Brugada Syndrome cause sudden death?

Brugada Syndrome is a cause of sudden death, but only a very small percentage of affected individuals are at significant risk.

Detection and Diagnosis

How is Brugada Syndrome detected?

• Most cases are detected during ECGs conducted for unrelated reasons (e.g., employment screening, pre-surgical evaluations, routine primary care).
• It can also be discovered through family screening after a confirmed diagnosis in a relative, even if they show no previous symptoms.
• A minority of patients are diagnosed after presenting with symptoms like fainting, seizures, or cardiac arrest.

How is Brugada Syndrome diagnosed?

• Diagnosis is made through an electrocardiogram (ECG).
• If Brugada Syndrome is suspected but the ECG is normal, a pharmacological challenge test is conducted. This involves injecting medication to provoke ECG changes characteristic of Brugada Syndrome.
• Genetic testing can confirm the diagnosis, even if ECG abnormalities are absent, especially in family screenings.

When is suspicion of Brugada Syndrome high?

• A family history of sudden death before age 50, especially during sleep or following a fever in the days leading up to the incident.
• During family screening for a diagnosed patient.
• Unexplained cardiac arrest.

What is the pharmacological challenge test for Brugada Syndrome?

• This test is performed when suspicion is high, but the initial ECG is normal.
• It involves continuous ECG monitoring (for at least an hour) after administering a medication to provoke Brugada Syndrome markers in the ECG.
• The test is outpatient, does not require anesthesia, and only necessitates fasting for 3 hours beforehand. It is considered safe and quick, with patients resuming normal activities afterward.
• Side effects are rare (<1%) and may include mild dizziness or a slight drop in blood pressure, which can be managed with IV fluids.
• The test is not recommended for individuals with palpitations but no family history or sudden death cases.

After Diagnosis

What precautions should I take after a diagnosis of Brugada Syndrome?

• Avoiding fever: Fever is a major trigger for Brugada Syndrome in affected individuals. Fever-reducing medications should be used consistently during any infection or illness.
• Avoiding certain medications: Some drugs can exacerbate Brugada Syndrome and increase the risk of cardiac arrest. These include certain anti-arrhythmics, psychiatric medications, and anesthetics (a list is available).
• Avoiding drugs and alcohol: Substances like cocaine, cannabis, and alcohol should be avoided.

What are the complications of Brugada Syndrome?

• Most individuals experience no complications and lead normal lives.
• A small percentage may experience fainting, requiring a heart monitoring device.
• Rare cases may involve cardiac arrest, necessitating the implantation of a defibrillator.

How is Brugada Syndrome treated?

• Patients are categorized based on their risk of cardiac arrest:
• High risk: Patients with recurrent fainting or a prior cardiac arrest often require a defibrillator, heart monitoring device, or medications to regulate heart rhythm.
• Low risk: Most individuals fall into this category, with no serious symptoms. Treatment focuses on education and avoiding triggers.

Do all Brugada Syndrome patients need a defibrillator?

No, defibrillators are usually recommended only for those with cardiac arrests or fainting episodes due to arrhythmias.

Is genetic testing necessary after a Brugada Syndrome diagnosis?

Yes, genetic testing is recommended to identify mutations associated with the syndrome. If confirmed, family members should also undergo genetic testing.

Do my family members need screening for Brugada Syndrome?

Yes, first-degree relatives (parents, siblings, and children) of a diagnosed patient should undergo cardiac tests (ECG, pharmacological challenge, or echocardiograms) or genetic testing if a mutation is present.

Lifestyle Considerations

Can I get pregnant with Brugada Syndrome?

• Yes, pregnancy does not significantly increase risks for individuals with Brugada Syndrome.
• Fever during pregnancy should be managed with antipyretics.
• Some anesthetics used during labor (including epidurals) may interact with Brugada Syndrome. It’s crucial to inform the medical team about the diagnosis.

Can I undergo surgeries, including dental procedures, with Brugada Syndrome?

• Surgical procedures do not inherently increase complications, but some anesthetics (general, local, or epidural) may trigger issues. Inform your doctor, and a report detailing precautions will be provided.