BRUGADA SYNDROME: FROM DIAGNOSIS TO TREATMENT AND PREVENTION – CURRENT KNOWLEDGE
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.6413Keywords:
Brugada Syndrome, SCN5A, ECG, ICD, AblationAbstract
Brugada syndrome is a rare inherited cardiac arrhythmia disorder characterized by a high risk of sudden cardiac death in structurally normal hearts. This channelopathy is associated with syncope caused by ventricular tachyarrhythmias, especially among the male population. Current studies results show that this illness is not solely inherited in an autosomal dominant manner, which occurs in only 3 out of 10 patients. Intensive research has deepened the understanding of its genetic, electrophysiological and clinical aspects. However, Brugada syndrome remains a major diagnostic and therapeutic challenge, especially in asymptomatic patients and in risk stratification. The main type of treatment remains implantable cardioverter-defibrillator, but results of clinical studies show that epicardial ablation can also represent satisfactory results. This review provides a summarized synthesis of current knowledge on Brugada syndrome, including epidemiology, pathophysiology, genetic basis, clinical presentation, electrocardiographic characteristics and diagnostic criteria, risk stratification, treatment approaches and preventive measures in a comprehensive and detailed way.
References
Rattanawong, P., & Shen, W. K. (2026). Brugada syndrome risk scores: What we've learned and what's next. Frontiers in Cardiovascular Medicine, 12, 1715146. https://doi.org/10.3389/fcvm.2025.1715146
Scarà, A., Borrelli, A., Romano, S., & Sciarra, L. (2026). A case of Brugada syndrome… or something else? Behind type 1 Brugada pattern. Clinical Case Reports, 14(7), e73042. https://doi.org/10.1002/ccr3.73042
Campuzano, O., Grassi, S., Martínez-Barrios, E., Greco, A., Arena, V., Sarquella-Brugada, G., & Oliva, A. (2025). Brugada syndrome in the forensic field: What do we know to date? Frontiers in Cardiovascular Medicine, 12, 1618762. https://doi.org/10.3389/fcvm.2025.1618762
Kumar, A., Tantray, J., Kosey, S., Devi, C.H., & Prajapati, B.G. (2025). Decoding Brugada syndrome: A comprehensive analysis of pathophysiology, genetic foundations and advanced clinical management. Health Sciences Review, 16, 100238. https://doi.org/10.1016/j.hsr.2025.100238
Leung, H. T., Kwok, S. Y., Shih, F. Y., Lun, K. S., Yung, T. C., & Tsao, S. (2025). A tale of two conditions: Pediatric Brugada syndrome unveiled-navigating the challenges of coexisting arrhythmia and fever-induced ECG pattern. Annals of Noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc, 30(1), e70009. https://doi.org/10.1111/anec.70009
Shimizu, W., Matsuo, K., Kokubo, Y., Satomi, K., Kurita, T., Noda, T., Nagaya, N., Suyama, K., Aihara, N., Kamakura, S., Inamoto, N., Akahoshi, M., & Tomoike, H. (2007). Sex hormone and gender difference--role of testosterone on male predominance in Brugada syndrome. Journal of Cardiovascular Electrophysiology, 18(4), 415–421. https://doi.org/10.1111/j.1540-8167.2006.00743.x
Griffiths, R. L. M., Walsh, R., Futema, M., Specterman, M., & Behr, E. R. (2026). Brugada syndrome: An exemplar for the genomic basis of sudden death. European Journal of Human Genetics: EJHG, 34(7), 904–913. https://doi.org/10.1038/s41431-025-01972-0
Gaal, S., Meszaros, B., Volko, J., Bilakovics, N., Naseem, M. U., Pethő, Z., Sandorfi, G., Menko, G., Voros, O., Balogh, I., Panyi, G., Csanadi, Z., & Szanto, T. G. (2026). Characterization of the R893C NaV1.5 mutation in Brugada syndrome. Frontiers in Cardiovascular Medicine, 13, 1726536. https://doi.org/10.3389/fcvm.2026.1726536
Krahn, A. D., Behr, E. R., Hamilton, R., Probst, V., Laksman, Z., & Han, H. C. (2022). Brugada syndrome. JACC. Clinical Electrophysiology, 8(3), 386–405. https://doi.org/10.1016/j.jacep.2021.12.001
Bhardwaj, P., Stavnem, D., Jacobsen, S. B., Winkel, B. G., & Tfelt-Hansen, J. (2025). Current perspectives on risk prediction and genetic basis of Brugada syndrome. Frontiers in Cardiovascular Medicine, 12, 1722105. https://doi.org/10.3389/fcvm.2025.1722105
Dababneh, S., Ardehali, A., Badesha, J., & Laksman, Z. (2025). The utility of genome-wide association studies in inherited arrhythmias and cardiomyopathies. Genes, 16(12), 1448. https://doi.org/10.3390/genes16121448
Behr, E. R., Ben-Haim, Y., Ackerman, M. J., Krahn, A. D., & Wilde, A. A. M. (2021). Brugada syndrome and reduced right ventricular outflow tract conduction reserve: A final common pathway? European Heart Journal, 42(11), 1073–1081. https://doi.org/10.1093/eurheartj/ehaa1051
Okada, J. I., Washio, T., Hisada, T., & Sugiura, S. (2025). Low expression levels of sodium channels in the right ventricular outflow tract underly the genesis of the characteristic electrocardiogram waveform in Brugada syndrome. Circulation Journal : official journal of the Japanese Circulation Society, 90(1), 78–87. https://doi.org/10.1253/circj.CJ-24-0814
Cabiati, M., Vozzi, F., Persiani, E., Piacenti, M., Rossi, A., Sgalippa, A., Cecchettini, A., Solarino, G., Zucchelli, G., Mazzocchetti, L., Notarstefano, P., Guiducci, L., Morales, M. A., & Del Ry, S. (2026). Exosomal CNP and cnp-related microRNAs: An open window into Brugada syndrome? Biomedicines, 14(5), 1094. https://doi.org/10.3390/biomedicines14051094
Martini B. (2026). The history of the precordial early repolarization and sudden death syndrome, lately named Brugada syndrome. Journal of Clinical Medicine, 15(10), 3903. https://doi.org/10.3390/jcm15103903
Pieroni, M., Notarstefano, P., Oliva, A., Campuzano, O., Santangeli, P., Coll, M., Nesti, M., Carnevali, A., Fraticelli, A., Iglesias, A., Grassi, S., Brugada, R., & Bolognese, L. (2018). Electroanatomic and pathologic right ventricular outflow tract abnormalities in patients with Brugada syndrome. Journal of the American College of Cardiology, 72(22), 2747–2757. https://doi.org/10.1016/j.jacc.2018.09.037
Ciabatti, M., Notarstefano, P., Zocchi, C., Virgili, G., Bellocci, F., Olivotto, I., & Pieroni, M. (2025). Brugada syndrome: Channelopathy and/or cardiomyopathy. Cardiogenetics, 15(2), 17. https://doi.org/10.3390/cardiogenetics15020017
Xu, T., Wang, S., Wang, J., & Xing, J. (2025). Brugada syndrome update. Frontiers in Physiology, 15, 1520008. https://doi.org/10.3389/fphys.2024.1520008
Dib Nehme, R., Sinno, L., Shouman, W., Ziade, J. A., Ammar, L. A., Amin, G., Booz, G. W., & Zouein, F. A. (2025). Cardiac channelopathies: Clinical diagnosis and promising therapeutics. Journal of the American Heart Association, 14(9), e040072. https://doi.org/10.1161/JAHA.124.040072
Özkartal, T., Bergonti, M., Caputo, M. L., Pannone, L., de Asmundis, C., Compagnucci, P., Casella, M., Berne, P., Casu, G., Migliore, F., Martini, N., Faccenda, D., Scheirlynck, E., & Conte, G. (2026). Bradyarrhythmias and Brugada syndrome: Clinical features, long-term outcome and prognostic implications-the BruBra study. Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology: Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology, 28(6), euag131. https://doi.org/10.1093/europace/euag131
Zhao, B., Chen, Y., Gu, H., Feng, Z., & Yu, Z. (2026). Dietary and emotional triggers of ventricular fibrillation in Brugada syndrome: Insights from a long-term subcutaneous implantable cardioverter-defibrillator case report. AME Case Reports, 10, 56. https://doi.org/10.21037/acr-2025-275
Polovina, M. M., Vukicevic, M., Banko, B., Lip, G. Y. H., & Potpara, T. S. (2017). Brugada syndrome: A general cardiologist's perspective. European Journal of Internal Medicine, 44, 19–27. https://doi.org/10.1016/j.ejim.2017.06.019
Hamza, I., Végh, L., Sebestyén, V., Gulyás, E., Juhász, B., Somodi, S., Ratku, B., Szűcs, Z., Koczok, K., Balogh, I., Szabó, Z., & Ujvárosy, D. (2026). Type 1 Brugada pattern triggered by low-grade fever: Implications for diagnosis and risk stratification. International Journal of Molecular Sciences, 27(9), 3900. https://doi.org/10.3390/ijms27093900
Start, E., & Enabore, A. (2025). Case report: Lurasidone-induced type 2 Brugada pattern in a pediatric patient. Clinical Practice and Cases in Emergency Medicine, 9(3), 274–277. https://doi.org/10.5811/cpcem.1573
Zeppenfeld, K., Tfelt-Hansen, J., de Riva, M., Winkel, B. G., Behr, E. R., Blom, N. A., Charron, P., Corrado, D., Dagres, N., de Chillou, C., Eckardt, L., Friede, T., Haugaa, K. H., Hocini, M., Lambiase, P. D., Marijon, E., Merino, J. L., Peichl, P., Priori, S. G., Reichlin, T., … ESC Scientific Document Group (2022). 2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. European Heart Journal, 43(40), 3997–4126. https://doi.org/10.1093/eurheartj/ehac262
George Cherian, N., & Ravindranath, S. (2026). Beyond common arrhythmias: Discovering Brugada syndrome in a patient with nonspecific symptoms. Cureus, 18(2), e103952. https://doi.org/10.7759/cureus.103952
Gourraud, J. B., Barc, J., Thollet, A., Le Marec, H., & Probst, V. (2017). Brugada syndrome: Diagnosis, risk stratification and management. Archives of Cardiovascular Diseases, 110(3), 188–195. https://doi.org/10.1016/j.acvd.2016.09.009
Oh, H. J., Cho, H., Ko, K. Y., Kim, S. E., Cho, S. W., Kwak, J. J., & Hwang, J. W. (2026). Diagnosis and management of Brugada syndrome unmasked by flecainide challenge in a patient with unexplained ventricular fibrillation: A case report. Oxford Medical Case Reports, 2026(1), omaf301. https://doi.org/10.1093/omcr/omaf301
Behr, E. R., Winkel, B. G., Ensam, B., Alfie, A., Arbelo, E., Berry, C., Cerrone, M., Conte, G., Crotti, L., Corcia, C. M. G., Kaski, J. C., Nademanee, K., Postema, P. G., Priori, S., Probst, V., Sarquella-Brugada, G., Schulze-Bahr, E., Tadros, R., Wilde, A., Tfelt-Hansen, J., … Veltmann, C. (2025). The diagnostic role of pharmacological provocation testing in cardiac electrophysiology: A clinical consensus statement of the European heart rhythm association and the European association of percutaneous cardiovascular interventions (eapci) of the ESC, the ESC working group on cardiovascular pharmacotherapy, the association of European paediatric and congenital cardiology (AEPC), the paediatric & congenital electrophysiology society (paces), the heart rhythm society (HRS), the Asia pacific heart rhythm society (aphrs), and the latin American heart rhythm society (lahrs). Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology: Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellularelectrophysiology of the European Society of Cardiology, 27(4), euaf067. https://doi.org/10.1093/europace/euaf067
Rattanawong, P., Kulthamrongsri, N., & Chung, E. H. (2026). Exercise and exercise stress testing in Brugada syndrome: Diagnostic, prognostic, and safety implications. JACC. Asia, 6(6), 848–859. https://doi.org/10.1016/j.jacasi.2026.03.021
Melpignano, A., Vocale, L. R., Vitali, F., Canovi, L., Gibiino, F., Bianchi, C., Malagù, M., Balla, C., & Bertini, M. (2026). SMARTBrugada study: Smartwatch marginosternal application for recording type I Brugada pattern. Heart Rhythm, S1547-5271(26)02350-7. Advance online publication. https://doi.org/10.1016/j.hrthm.2026.04.060
Pannone, L., Bisignani, A., Osei, R., Gauthey, A., Sorgente, A., Monaco, C., Della Rocca, D. G., Del Monte, A., Strazdas, A., Mojica, J., Al Housari, M., Miraglia, V., Mouram, S., Vetta, G., Paparella, G., Ramak, R., Overeinder, I., Bala, G., Almorad, A., Ströker, E., … de Asmundis, C. (2024). Genetic testing in Brugada syndrome: A 30-year experience. Circulation. Arrhythmia and Electrophysiology, 17(4), e012374. https://doi.org/10.1161/CIRCEP.123.012374
Santinelli, V., & Hocini, M. (2026). Editorial: Past, present, and future of Brugada syndrome: A comprehensive framework. Frontiers in Cardiovascular Medicine, 13, 1851845. https://doi.org/10.3389/fcvm.2026.1851845
Gaita, F., Cerrato, N., Giustetto, C., Martino, A., Bergamasco, L., Millesimo, M., Barbonaglia, L., Carvalho, P., Caponi, D., Saglietto, A., Bonacchi, G., Bianchi, F., Silvetti, E., Crescenzi, C., Canestrelli, S., De Maio, M., De Ferrari, G. M., Musumeci, G., Rametta, F., Scaglione, M., … Calò, L. (2023). Asymptomatic patients with Brugada ECG pattern: Long-term prognosis from a large prospective study. Circulation, 148(20), 1543–1555. https://doi.org/10.1161/CIRCULATIONAHA.123.064689
Gaita, F., Cerrato, N., Giustetto, C., Garberoglio, L., & Calò, L. (2024). Brugada syndrome: Identification of subjects at risk and therapy. European Heart Journal Supplements: Journal of the European Society of Cardiology, 26(Suppl 1), i69–i73. https://doi.org/10.1093/eurheartjsupp/suae021
Migliore, F., Ottaviano, L., Arestia, A., Nigro, G., Dello Russo, A., Viani, S., Bianchi, V., Bisignani, A., Pieragnoli, P., Vitulano, G., Rordorf, R., Francia, P., Taravelli, E., Pisanò, E., Lavalle, C., Brambilla, R., Ziacchi, M., Rapacciuolo, A., Viscusi, M., De Filippo, P., … S-ICD Rhythm Detect Investigators (2025). Subcutaneous implantable defibrillator therapy in patients with Brugada syndrome: Data from a large multicenter registry. JACC. Clinical Electrophysiology, 11(7), 1572–1582. https://doi.org/10.1016/j.jacep.2025.03.003
Nademanee, K., Wilde, A. A., Ackerman, M. J., R Behr, E., Bezzina, C. R., Chen, P. S., Chung, F. P., Coronel, R., Haissaguerre, M., Jiang, C., Juang, J. J., Khongphatthanayothin, A., Makita, N., Morita, H., Nakagawa, H., Ngarmukos, T., Nogami, A., Pappone, C., Priori, S. G., Rosso, R., … Viskin, S. (2026). Contemporary perspectives on J-Wave syndromes: An expert consensus statement. Journal of Arrhythmia, 42(1), e70284. https://doi.org/10.1002/joa3.70284
McBenedict, B., Alphonse, B., Devan, J. N., Singh, G., Goh, K. S., Yau, R. C. C., Elamin, S., Jamched, V., Abraham, A. A., Valentim, G., Lima Pessôa, B., & Hauwanga, W. N. (2024). Advances and challenges in the management of Brugada syndrome: A comprehensive review. Cureus, 16(6), e61837. https://doi.org/10.7759/cureus.61837
Chipa-Ccasani, F., Brugada, J., Luján, A. L., Martínez-Barrios, E., Díez-Escuté, N., Merchan Pinto, E. F., Campuzano, O., Cruzalegui, J., Greco, A., & Sarquella-Brugada, G. (2026). Cardioneuroablation restoring atrioventricular conduction in Brugada syndrome: A device-free approach. JACC. Case Reports, 31(21), 107843. https://doi.org/10.1016/j.jaccas.2026.107843
Byrne, L., Mannion, J., Sanaullah, W., Joseph Galvin, J. (2026). Combined epicardial substrate ablation and pulsed field pulmonary vein isolation in Brugada syndrome. Heart Rhythm Case Reports, 05.022. https://doi.org/10.1016/j.hrcr.2026.05.022
Byers, M. E., & Beer, D. A. (2026). Epicardial substrate ablation in gene-negative Brugada syndrome: U.S. experience and mechanistic insights. JACC. Case Reports, 31(20), 108237. https://doi.org/10.1016/j.jaccas.2026.108237
Hoogendijk, M. G., Yap, S. C., & Boukens, B. J. (2026). Using monophasic potential mapping to visualize the Brugada substrate. Heart Rhythm, S1547-5271(26)02341-6. Advance online publication. https://doi.org/10.1016/j.hrthm.2026.03.1969
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Norbert Krawczyk, Natalia Krzysztofek, Olaf Krawczyk, Monika Kamela, Piotr Wilczkowski, Aleksandra Palka, Małgorzata Grzybowska, Wojciech Kopyciński, Katarzyna Boszczyk, Adrianna Baran
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
