Brugada syndrome (BS) and syncope: a complex therapeutic issue

Area of Science:

• Cardiology
• Neurology

Background:

• Brugada syndrome (BS) is an inherited cardiac condition associated with an increased risk of ventricular arrhythmias and sudden cardiac death.
• Syncope in BS patients necessitates careful evaluation to determine the underlying cause and appropriate management.

Observation:

• A 66-year-old male with a history of BS presented with recurrent syncope and sphincter incontinence.
• Initial investigations including electrophysiologic studies did not reveal sustained ventricular arrhythmias, leading to conservative management.
• Electrocardiogram (ECG) revealed ST coved-type elevation with right bundle branch block pattern, characteristic of BS.

Findings:

• Despite negative electrophysiologic studies, the patient's symptomatic presentation prompted further investigation.
• An implantable cardioverter defibrillator (ICD) was successfully implanted due to the recurrent syncope in the context of BS.
• The patient was diagnosed with syncope secondary to BS and hypertension.

Implications:

• This case underscores the importance of arrhythmogenic risk stratification in BS patients, particularly those experiencing syncope.
• The decision to implant an ICD in symptomatic BS patients is generally accepted, though controversial in asymptomatic individuals with only ECG findings.
• Clinical expertise and consensus are crucial for managing complex diagnostic and therapeutic challenges in BS.