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Asymptomatic Brugada Management — EECC MCQ

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ModerateArrhythmia & ElectrophysiologyAsymptomatic Brugada ManagementEECC

A 45-year-old man is found to have a type 1 Brugada ECG pattern (coved ST elevation ≥2 mm in V1-V2 followed by a negative T wave). He has no symptoms, no family history of SCD, and no inducible arrhythmias on EP study. What is the recommended management?

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Correct answer: E — Clinical observation with avoidance of Brugada-triggering factors (fever — treat promptly with antipyretics, certain drugs, excessive alcohol) and periodic follow-up; ICD is not routinely recommended for asymptomatic patients with no risk factors

The 2022 ESC VA/SCD Guidelines stratify Brugada syndrome management: (1) ICD recommended (Class I): cardiac arrest survivors, documented spontaneous sustained VT; (2) ICD should be considered (Class IIa): spontaneous type 1 pattern with syncope of arrhythmic origin; (3) ICD may be considered (Class IIb): spontaneous type 1 with inducible VF on EP study; (4) conservative management for asymptomatic patients with no risk factors. Key preventive measures for ALL Brugada patients: avoid drugs that unmask/worsen Brugada (www.brugadadrugs.org — sodium channel blockers, certain antidepressants, cocaine), promptly treat fever (which can unmask the pattern and trigger arrhythmias), avoid excessive alcohol, and avoid vagotonic states. Quinidine (Class IIa) and epicardial catheter ablation are options for recurrent arrhythmias.

Reference: ESC (2022): Guidelines on VA and SCD Prevention