INTRODUCTION
Brugada syndrome (BrS) is an inherited arrhythmogenic disorder, characterized by ST-segment elevation with typical ECG type-1 pattern in the right precordial leads and an increased risk of ventricular fibrillation (VF).1 The prevalence of BrS is estimated to be 1–5 per 10,000 inhabitants worldwide, but the real incidence of sudden cardiac death (SCD) in these patients remains uncertain.2 The electrocardiographic (ECG) pattern is dynamic and high precordial leads (HPL) increase BrS recognition.3
Recent studies have shown that the absolute risk of asymptomatic patients who develop ventricular tachycardia or fibrillation (VT/VF) might have been overestimated in the past.4{Casado-Arroyo, 2016, Long-Term Trends in Newly Diagnosed Brugada Syndrome: Implications for Risk Stratification}{Casado-Arroyo, 2016, Long-Term Trends in Newly Diagnosed Brugada Syndrome: Implications for Risk Stratification}{Casado-Arroyo, 2016, Long-Term Trends in Newly Diagnosed Brugada Syndrome: Implications for Risk Stratification}{Milman, 2017, Age of First Arrhythmic Event in Brugada Syndrome: Data From the SABRUS (Survey on Arrhythmic Events in Brugada Syndrome) in 678 Patients}{Casado-Arroyo, 2016, Long-Term Trends in Newly Diagnosed Brugada Syndrome: Implications for Risk Stratification}{Casado-Arroyo, 2016, Long-Term Trends in Newly Diagnosed Brugada Syndrome: Implications for Risk Stratification}Symptomatic BrS subjects who once experienced cardiac syncope or aborted SCD (aSCD) have a known high risk of VF recurrence. Currently, guidelines provide recommendations for the management of symptomatic patients. On the contrary, there is no consensus for the asymptomatic patients and the management depends on evaluation of different parameters and the decision is usually personalized. The risk stratification of these patients has still been one of the most challenging and unresolved clinical questions. Several clinical, ECG and electrophysiological markers have been proposed to provide optimal risk stratification.5 However, differences in life-threatening events rates among studies and the lower risk profile demonstrated nowadays might impact these observations.6
The implantable cardioverter defibrillator (ICD) remains the most effective therapy for SCD prevention,7 however ICD complications should be considered, especially in young subjects.8
Registries assessing clinical aspects and long-term outcomes of patients with BrS are still needed to confirm data from the prior studies to identify patients at risk of SCD. In addition, the Brazilian population is not well represented in worldwide studies. The aim of the present study was to explore the association of invasive and non-invasive parameters such as ECG markers, EPS data and genetic testing with symptoms, in a cohort of type-1 BrS patients.