Brugada Syndrome and Exercise: Is It Time for a Paradigm Change?

Despite the multiple benefits of exercise for health, exercise in the presence of arrhythmic disorders can trigger adverse clinical events, including sudden cardiac death (SCD). The aim of this narrative review is to summarize the most recent recommendations regarding physical activity and exercise in individuals with Brugada Syndrome (BrS).

An advanced literature search was performed on the Pubmed and clinicaltrials.gov databases and published articles/clinical trials registered until September 2024 were analyzed. The final analysis included 33 articles.

Despite initial reports suggesting a higher risk of SCD in BrS, the risk is not as high as expected, and there is no evidence that exercise is an independent predictor. Therefore, scientific recommendations have become less restrictive. However, consensus on risk scores is lacking, making the evaluation of BrS a real challenge. The most recent recommendations emphasize individual evaluation, risk stratification, shared decision-making, and general preventive measures, allowing asymptomatic BrS patients as well as genotype positive/phenotype negative patients to participate in competitive sports, excluding sports under extreme conditions. Regarding patients with an implantable cardioverter defibrillator, both leisure and competitive sports may be considered in asymptomatic patients, avoiding contact sports.

Research on the relationship between exercise and cardiovascular disease is evolving, but evidence-based recommendations for sports in BrS patients are scarce and further studies are needed.