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.