As part of conservative management, advise the patient to:[1]Krahn AD, Behr ER, Hamilton R, et al. Brugada syndrome. JACC Clin Electrophysiol. 2022 Mar;8(3):386-405.
https://www.sciencedirect.com/science/article/pii/S2405500X2101080X?via%3Dihub
http://www.ncbi.nlm.nih.gov/pubmed/35331438?tool=bestpractice.com
[7]Zeppenfeld K, Tfelt-Hansen J, de Riva M, et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2022 Oct 21;43(40):3997-4126.
https://academic.oup.com/eurheartj/article/43/40/3997/6675633?login=false
http://www.ncbi.nlm.nih.gov/pubmed/36017572?tool=bestpractice.com
Avoid drugs that could exacerbate the Brugada ECG pattern (for further information see:
BrugadaDrugs.org: safe drug use and the Brugada syndrome
Opens in new window).[18]Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm. 2018 Oct;15(10):e190-e252.
https://www.heartrhythmjournal.com/article/S1547-5271(17)31249-3/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/29097320?tool=bestpractice.com
[51]Priori SG, Wilde AA, Horie M, et al. Executive summary: HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes. Heart Rhythm. 2013;10(12):e85-108.
https://core.ac.uk/reader/82269654?utm_source=linkout
http://www.ncbi.nlm.nih.gov/pubmed/23916535?tool=bestpractice.com
Antiarrhythmics (particularly sodium-channel blockers)
Psychotropic drugs
Anaesthetics
Certain over-the-counter drugs (e.g., antihistamines)
Illicit drugs (e.g., cannabis, cocaine).
Treat any fever promptly[18]Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm. 2018 Oct;15(10):e190-e252.
https://www.heartrhythmjournal.com/article/S1547-5271(17)31249-3/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/29097320?tool=bestpractice.com
[51]Priori SG, Wilde AA, Horie M, et al. Executive summary: HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes. Heart Rhythm. 2013;10(12):e85-108.
https://core.ac.uk/reader/82269654?utm_source=linkout
http://www.ncbi.nlm.nih.gov/pubmed/23916535?tool=bestpractice.com
Avoid alcohol intoxication.[18]Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm. 2018 Oct;15(10):e190-e252.
https://www.heartrhythmjournal.com/article/S1547-5271(17)31249-3/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/29097320?tool=bestpractice.com
[51]Priori SG, Wilde AA, Horie M, et al. Executive summary: HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes. Heart Rhythm. 2013;10(12):e85-108.
https://core.ac.uk/reader/82269654?utm_source=linkout
http://www.ncbi.nlm.nih.gov/pubmed/23916535?tool=bestpractice.com
In addition, patients should discuss new medications with their cardiologist as appropriate.
Reassure patients that exercise is not a normal trigger for ventricular arrhythmias in Brugada syndrome. However, a post-vagal state following exercise has been reported.
Advise patients to contact their care team urgently if they have palpitations, syncope, or seizures. In addition, if they have an implantable cardioverter defibrillator (ICD) they should also report any syncope or ICD shocks.