Brugada syndrome risk factors

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Risk Factors: Agents and Scenarios that Provoke the Brugada Syndrome Pattern

The electrocardiographic findings of Brugada syndrome are often concealed, but can be unmasked or modulated by a number of drugs and pathophysiological states including:

• Ajmaline (a diagnostic test agent)
• Cocaine
• Fever
• Flecainide (a diagnostic test agent)
• In large studies, a family history of sudden cardiac death among patients with Brugada syndrome does not appear to be a risk factor for sudden cardiac death in siblings.
• Procainamide (a diagnostic test agent)
• Propranolol intoxication
• Sodium channel blockers (a diagnostic test agent)
• Tricyclic antidepressants
• Vagotonic agents that mimic sleep
• α-adrenergic agonists
• β-adrenergic blockers
• Tetracyclic antidepressants
• A combination of glucose and insulin
• Hyperkalemia
• Hypokalemia
• Hypercalcemia

Risk Statification

• Patients with syncope and an abnormal Type 1 ECG are at higher risk
• Asymptomatic patients at risk can be identified
  • Presence of spontaneous Type 1 ST-segment elevation
  • Characteristics of the S wave
  • Presence of late potentials
  • Inducibility of VT/VF using PES is controversial as a risk factor.