Brugada syndrome and fitness to fly: risk stratification in two pilot applicants

Brugada syndrome is a condition associated with a characteristic ECG and sudden arrhythmic death. Due to this risk of sudden death, patients with Brugada syndrome are generally not considered fit to fly. In recent years we have gained new insight into this condition and Brugada syndrome patients can now be classified into different risk categories. This then raises the question of whether a subset of patients with the Brugada syndrome exists in whom the risk of sudden death is sufficiently low and is compatible with fitness to fly. We discuss this question with two case reports of persons with Brugada syndrome who applied for an airman medical certificate and we propose an algorithm to aid decision making in this situation.