Management of Brugada Syndrome 2016: Should All High Risk Patients Receive an ICD? Alternatives to Implantable Cardiac Defibrillator Therapy for Brugada Syndrome.

Abstract

More than 20 years ago, the Brugada brothers reported 8 patients with recurrent episodes of aborted sudden death and no demonstrable heart disease having a peculiar ECG pattern of ST elevation in right precordial leads.1 The Brugada syndrome (BrS), one of the most devastating causes of sudden cardiac death (SCD) in relatively young patients with apparently normal heart, was born. In fact, it is likely that the first case of BrS was reported a few years before by Martini et al.2 The syndrome was recognized although not fully characterized even earlier in various southeastern Asian countries as responsible for mysterious cases of unexpected nocturnal SCD.3 Over the following 2 decades, extensive research on the clinical and ECG aspects, electrophysiological (EP) mechanism, genetic background, and management of the syndrome has been accomplished. Two consensus reports on the diagnostic criteria, risk stratification, and management of BrS were published in 20054 and 2013.5 Recent publication of several works dealing with various modes of management of BrS has raised questions about the optimal treatment that should be offered to these patients. Hereunder, I review these updated results and give my own viewpoint on the issue of management of BrS. See Response by Sieira and Brugada ### Importance of ECG Phenotype Ascertainment Although there has been general initial consensus about the ECG definition of Brugada ECG pattern into 3 types (type 1, type 2, and type 3),4 there has been a recent effort to establish a more simplified mode of classification, including only 2 ECG patterns6: pattern 1 identical to the classic type 1 of other consensus (coved pattern) and pattern 2 that joins patterns 2 and 3 of previous consensus (saddle-back pattern). This is in agreement with the classification presently adopted by most specialists that differentiates Brugada ECG type 1 versus non-type …