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Brugada Syndrome — EECC MCQ

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HardArrhythmia & ElectrophysiologyBrugada SyndromeEECC

A 28-year-old man is referred following an out-of-hospital cardiac arrest with documented ventricular fibrillation. He was successfully resuscitated and is neurologically intact. His resting 12-lead ECG shows coved ST-segment elevation of 2 mm or more in V1-V2 with T-wave inversion (Type 1 Brugada pattern). Echocardiography and cardiac MRI are normal. Genetic testing reveals an SCN5A pathogenic variant. What is the most appropriate management?

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Correct answer: A — Implantable cardioverter-defibrillator

Explanation lettering: D = shown as B · E = shown as C · C = shown as D · B = shown as E

This patient has Brugada syndrome with a survived cardiac arrest. Per the 2022 ESC VA/SCD Guidelines, an ICD is recommended for secondary prevention (Class I). Quinidine (B) may be considered adjunctively but not as sole therapy after cardiac arrest. A flecainide challenge (C) is unnecessary with spontaneous Type 1 pattern. Ablation (D) may be considered for recurrent shocks. Observation (E) is inappropriate after aborted SCD.

Reference: ESC (2022): Guidelines for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death