How should I approach the management of a patient with Brugada Syndrome who presents with syncope?

In managing a patient with Brugada syndrome who presents with syncope, urgent cardiology referral is essential due to the risk of life-threatening arrhythmias and sudden cardiac death associated with this inherited arrhythmia syndrome ¹. The initial assessment should include a detailed history, family history of sudden cardiac death or inherited cardiac conditions, and a 12-lead ECG to confirm the Brugada pattern and assess for arrhythmic risk ¹. Echocardiography may be performed to exclude structural heart disease ¹.

Given the high-risk nature of syncope in Brugada syndrome, further specialist investigations such as electrophysiological studies may be warranted to assess inducibility of ventricular arrhythmias ¹. Implantable cardioverter defibrillator (ICD) insertion is the mainstay of treatment for patients with Brugada syndrome who have syncope presumed to be arrhythmic in origin, as it significantly reduces the risk of sudden cardiac death ¹.

While lifestyle advice and avoidance of known triggers (such as fever, certain medications, and excessive alcohol) are important adjuncts, they do not replace the need for specialist assessment and potential device therapy ¹. Patients should be advised on fitness to drive restrictions and safety at work due to the risk of sudden syncope and arrhythmia ¹.

Recent literature emphasizes a symptom-based approach integrating risk stratification with electrophysiological testing and genetic analysis to tailor management, but the cornerstone remains specialist cardiology evaluation and ICD consideration in syncope cases (Cepeda-Nieto et al., 2025).