Brugada syndrome

Diagnosis

The diagnosis of Brugada syndrome often involves performing a physical exam, evaluating one’s medical and family history, and doing several tests.

Brugada syndrome is often diagnosed in adults and, in rare cases, teenagers. Because the symptoms are generally missing in young children, it is rarely detected. Tests are performed to monitor the heartbeat and to diagnose Brugada syndrome.

• Physical examination: During a physical exam, the healthcare provider will check the heart through a stethoscope.
• Electrocardiogram (ECG or EKG): A typical Brugada syndrome pattern may not be present at the first ECG, repeating the test two more times may be necessary. To capture the pattern, they may relocate the sensors between tests. This test measures the electrical activity in the heart that causes it to beat. Sensors or electrodes are placed on the chest and sometimes the limbs during the test.

A 24-hour Holter monitor test may be recommended if the heart rhythm appears regular during the initial examination. This portable device monitors the heart continuously for a full 24-hour period.

In some cases, additional ECGs may be requested of those who suffer from the disease, but their initial electrocardiograms (ECGs) and 24-hour Holter tests are within the normal range. The healthcare provider may give medication before doing an EKG to help the Brugada pattern appear on the EKG printout. This may be referred to as a drug challenge test. Medications are often administered via IV that might cause an irregular heartbeat.

• Echocardiogram: While this test alone cannot provide a diagnosis for Brugada syndrome, it can assist in identifying any structural abnormalities present in the heart. By utilizing sound waves, an echocardiogram generates images of the heart.
• Electrophysiological (EP) testing and mapping: During the procedure, catheters are inserted into the heart via the femoral or leg veins. These catheters detect electrical activity within the heart. This test may be ordered if the diagnosis remains unclear following previous tests. EP study is a detailed evaluation of the electrical activity in the heart.

Treatment

Brugada syndrome does not have a specific cure. The primary objective of treatment is to prevent ventricular arrhythmias and manage them if they occur. Asymptomatic individuals with this condition may not require immediate treatment, but they are often advised to take measures to reduce the risk of irregular heartbeats. This can involve lifestyle adjustments and avoiding known triggers that may exacerbate the condition. Regular monitoring and follow-up with healthcare providers are essential to ensure early detection and appropriate management if symptoms or complications arise.

The treatment of Brugada syndrome is based on the risk of having a significantly irregular heartbeat. People with personal history of significant arrhythmias, fainting spells, or survivors of sudden cardiac arrest are at high risk.

Medication, catheter therapies, or surgery to implant a device that controls the heartbeat are among the treatment options.

• Medications: Individuals diagnosed with Brugada syndrome may receive medical treatment in the form of medications, such as quinidine, to mitigate the risk of developing a potentially life-threatening heart rhythm. In some cases, doctors may prescribe these medications either as standalone therapy or in combination with an implantable cardioverter-defibrillator (ICD) to regulate and stabilize the heart’s rhythm.
• Treating fever: It is advisable to promptly utilize medications that help reduce fever at the initial indication of an elevated body temperature. Individuals with Brugada syndrome are susceptible to experiencing irregular heart rhythms when they have fever.
• Avoid triggering medications of an irregular heartbeat: Informing the healthcare provider of all medications including over-the-counter prescriptions and vitamins one is taking is essential in managing Brugada syndrome. Excessive alcohol consumption, some heart medications, and antidepressants, might raise the risk of an irregular heartbeat.
• Avoid participating in competitive sports: People who are at high risk of having a significant abnormal heart rhythm should consult their healthcare provider before engaging in competitive sports.
• Surgery or other procedures: Surgery or a catheter treatment may be recommended to patients with Brugada syndrome who have suffered a cardiac arrest or a frightening fainting episode.
  • Implantable cardioverter-defibrillator (ICD): An overnight hospital stay is frequently required for implanted cardioverter-defibrillator (ICD) installation. ICD uses electrical shocks to correct irregular heartbeats as necessary. This compact, battery-powered gadget is implanted in the chest to monitor the heart rhythm continually.
    While implantable cardioverter-defibrillators (ICDs) are valuable medical devices, they are not infallible. There are potential risks associated with their use, such as the possibility of delivering a shock at an inappropriate time, experiencing malfunctioning leads, or developing infections.
  • Radiofrequency catheter ablation: This procedure involves the insertion of a catheter through a blood vessel, which is then guided to the heart. Through the catheter, high-energy radiofrequency waves are delivered to intentionally create scar tissue or destroy the heart tissue responsible for the irregular heart rhythm. Radiofrequency catheter ablation may be recommended in cases where an ICD fails to adequately and safely manage symptoms associated with Brugada syndrome.

For individuals with Brugada syndrome, regular health checkups play a vital role in effectively managing and controlling this heart rhythm disorder. These routine examinations serve to promptly detect any potential complications and assess the need for treatment adjustments if required.

Additionally, it is crucial to steer clear of factors known to trigger Brugada syndrome symptoms and promptly report any unusual occurrences to healthcare providers. By adhering to these practices, individuals can better safeguard their health and enhance their overall well-being while living with this condition.