Treatment of Brugada Syndrome with Type 1 Brugada ECG Pattern and Arrhythmic Syncope

Clinical Scenario

This protocol is specific to patients with a confirmed type 1 Brugada ECG pattern who have experienced arrhythmic syncope. This combination defines a higher-risk subgroup where the nature of the ECG pattern and the character of the syncopal episode are both central to management decisions.

Key Consideration

ICD implantation should be considered in patients with type 1 Brugada pattern and an arrhythmic syncope. Not all patients are candidates, however — device-related contraindications, patient preference, and specific arrhythmic events each influence the decision pathway.

Treatment Approach

Pharmacological therapy has a defined role in this population. Specific agents are indicated for patients with device-related considerations or recurrent events — the full protocol specifies which agents apply, under which conditions, and what alternatives exist.

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References

DOI: 10.1093/eurheartj/ehac262
ICD implantation should be considered in patients with type 1 Brugada pattern and an arrhythmic syncope.
Quinidine should be considered in patients with BrS who qualify for an ICD but have a contraindication, decline, or have recurrent ICD shocks.
Cilostazol (phosphodiesterase-3 inhibitor) can be an alternative to quinidine.
Isoproterenol infusion should be considered in BrS patients suffering electrical storm.
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