To differentiate Brugada Syndrome from other causes of syncope, a detailed clinical and family history is essential, focusing on syncope characteristics, family history of sudden cardiac death under 40 years, and any history of arrhythmic events or structural heart disease NICE CKS,NICE CG109. Brugada Syndrome typically presents with syncope due to ventricular arrhythmias, often occurring at rest or during sleep, and may be associated with a family history of sudden cardiac death or known inherited cardiac conditions NICE CKS,NICE CG109.
Perform a 12-lead ECG to identify the characteristic Brugada pattern—coved-type ST-segment elevation in the right precordial leads (V1-V3)—which is diagnostic NICE CKS. This ECG pattern distinguishes Brugada Syndrome from other syncope causes such as vasovagal syncope, postural hypotension, or epilepsy, which do not show this specific ECG abnormality NICE CKS,NICE CG109.
In contrast, vasovagal syncope often has identifiable triggers (e.g., prolonged standing, pain) and prodromal symptoms like sweating or warmth, and situational syncope is provoked by specific actions such as coughing or micturition NICE CKS,NICE CG109. Epileptic seizures have features such as tongue biting, postictal confusion, and witnessed abnormal movements, which are absent in Brugada Syndrome NICE CG109.
For patients with suspected cardiac arrhythmic syncope, including Brugada Syndrome, ambulatory ECG monitoring (Holter or implantable loop recorder) is recommended to detect arrhythmias, as Brugada Syndrome can cause polymorphic ventricular tachyarrhythmias without structural heart disease NICE CKS,NICE CG109[Viskin & Belhassen 1998].
Referral to cardiology for specialist assessment including echocardiography and possibly electrophysiological studies is indicated if Brugada Syndrome is suspected, especially if the ECG is suggestive or there is a family history of sudden cardiac death NICE CKS,NICE CG109. Genetic testing may also be considered as Brugada Syndrome is an inherited channelopathy related to sodium channel mutations, which can overlap with other inherited arrhythmia syndromes such as Long QT syndrome [Cerrone et al. 2001].
In summary, differentiation relies on clinical history, characteristic ECG findings, exclusion of other causes by history and examination, and specialist cardiac investigations including ambulatory ECG and possibly genetic testing NICE CKS,NICE CG109[Viskin & Belhassen 1998; Cerrone et al. 2001].
Key References
- CKS - Blackouts and syncope
- CG109 - Transient loss of consciousness ('blackouts') in over 16s
- CKS - Palpitations
- (Viskin and Belhassen, 1998): Polymorphic ventricular tachyarrhythmias in the absence of organic heart disease: classification, differential diagnosis, and implications for therapy.
- (Cerrone et al., 2001): [Long QT syndrome and Brugada syndrome: 2 aspects of the same disease?].