Brugada syndrome

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 9 Aug 2025

Last updated: 19 Mar 2024

Brugada syndrome (BrS) (also known as sudden unexplained [or unexpected] nocturnal death syndrome and as idiopathic ventricular fibrillation) should be suspected in any patient with a past history of any one or more of unexplained cardiac arrest, ventricular arrhythmia (e.g., documented polymorphic ventricular tachycardia or ventricular fibrillation) of unknown cause, or cardiogenic syncope. Be aware that patients may also present asymptomatically with incidental findings of Brugada pattern on ECG, or through family screening.

Diagnosis of BrS is considered probable or definite if spontaneous type 1 Brugada pattern is recorded on ECG from the 2nd to 4th intercostal spaces. Induced type 1 Brugada pattern (e.g., by fever, medications such as sodium-channel blockers, or by psychotropic drugs, alcohol, or illicit drugs) or type 2 or 3 Brugada pattern on the ECG is not diagnostic, and requires further investigation. However, diagnosis of BrS should be made by a specialist, and requires synthesis of ECG findings and features of the history (which should include relevant family history) and physical exam.

Treatment consists of conservative management and primary and secondary prevention of serious arrhythmic events. This aims to prevent serious arrhythmic events, while avoiding potential complications of any treatments. Nonconservative treatments include implantable cardioverter defibrillator (ICD), pharmacologic therapy, and radiofrequency catheter ablation.

Definition

Brugada syndrome (BrS) (also known as sudden unexplained [or unexpected] nocturnal death syndrome and as idiopathic ventricular fibrillation) is an inherited channelopathy characterized by a typical pattern of ST-segment elevation in the precordial leads V1-V3, and is associated with increased risk of serious arrhythmic events such as ventricular arrhythmias and cardiac arrest.[1] BrS is typically first diagnosed in young- to middle-aged patients and is rare in children.[1][2][3]

The diagnosis and management of BrS in children is not covered in this topic.

History and exam

Key diagnostic factors

past history of unexplained cardiac arrest or documented PMVT or VF
cardiogenic syncope

Full details

Other diagnostic factors

inducible features of Brugada syndrome
atrial arrhythmias
nocturnal agonal respirations

Full details

Risk factors

age 30 to 50 years
male sex
Asian ancestry
family history of BrS or suspicious or unexplained cardiac death

Full details

Diagnostic tests

1st tests to order

ECG
echocardiogram

Full details

Tests to consider

provocative drug testing with sodium channel blockade
genetic testing for BrS
advanced cardiac imaging (MRI or CT)
invasive electrophysiological (EP) study with inducibility testing for ventricular arrhythmias

Full details

Treatment algorithm

INITIAL

with acute ventricular arrhythmia

ACUTE

asymptomatic

symptomatic

Contributors

Authors

Eugene H Chung, MD, MPH

Professor of Internal Medicine

Director of Sports Electrophysiology Clinic

Massachusetts General Hospital

Harvard Medical School

Boston

Disclosures

EHC declares that he has no competing interests.

Acknowledgements

Professor Eugene H Chung would like to gratefully acknowledge Dr Mohammed-Ali Jazayeri for his contribution to the initial drafts of this topic.

Disclosures

MAJ declares that he has no competing interests.

Peer reviewers

Sei Iwai, MD

Section Chief, Cardiac Electrophysiology

Department of Cardiology

Westchester Medical Center Health Network

Valhalla

Disclosures

SI declares that he has no competing interests.

Amanda Varnava, MA(Hons), MD, FRCP

Consultant Cardiologist

Imperial College Healthcare Trust

London

Disclosures

AV declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Krahn AD, Behr ER, Hamilton R, et al. Brugada syndrome. JACC Clin Electrophysiol. 2022 Mar;8(3):386-405.Full text Abstract

Cronin EM, Bogun FM, Maury P, et al. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Europace. 2019 Aug 1;21(8):1143-4.Full text Abstract

Priori SG, Wilde AA, Horie M, et al. HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes: document endorsed by HRS, EHRA, and APHRS in May 2013 and by ACCF, AHA, PACES, and AEPC in June 2013. Heart Rhythm. 2013;10(12):1932-63.Full text Abstract

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.Full text Abstract

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.Full text Abstract

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.Full text Abstract

Nielsen JC, Lin YJ, de Oliveira Figueiredo MJ, et al. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population. J Arrhythm. 2020 Jun 15;36(4):553-607.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Acute coronary syndrome
- Arrhythmogenic cardiomyopathy
- Athlete’s heart
More Differentials
Guidelines
- 2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death
- 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death
More Guidelines
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Brugada syndrome

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

with acute ventricular arrhythmia

asymptomatic

symptomatic

Contributors

Authors

Eugene H Chung, MD, MPH

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Sei Iwai, MD

Disclosures

Amanda Varnava, MA(Hons), MD, FRCP

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice