People often first notice Brugada syndrome when a fainting spell happens out of the blue, especially during sleep or when resting after a fever or heavy meal, and sometimes after certain medications or alcohol. In families with a history of sudden cardiac death at a young age, doctors may suspect it earlier and confirm it with an electrocardiogram (ECG) showing a characteristic pattern, sometimes revealed only during a fever or with a specialized medication challenge. For many, the first signs of Brugada syndrome are subtle or absent, so it’s often first noticed after an episode of unexplained fainting, nighttime gasping or abnormal breathing, or a concerning ECG found during evaluation.
Condition
Brugada syndrome
This condition has the following symptoms:
FaintingHeart palpitationsNighttime gaspingSeizure-like episodesDizzinessCardiac arrestBrugada syndrome is a heart rhythm condition that can cause dangerous irregular beats. It often has no symptoms, but some people faint, feel palpitations, or have sudden nighttime gasping. Many people with Brugada syndrome are diagnosed in adulthood, and patterns can run in families. The condition is lifelong, and the risk of sudden cardiac death is highest in those with fainting or proven abnormal rhythms. Treatment focuses on preventing dangerous rhythms with an implantable cardioverter-defibrillator and avoiding triggers like fever and certain medicines.
Short Overview
Symptoms
Brugada syndrome often has no symptoms. When present, features include fainting, nighttime gasping or agonal breathing, palpitations, seizures, and sudden cardiac arrest—often during rest, sleep, or fever. Early symptoms of Brugada syndrome may be unexplained fainting or loss of consciousness.
Outlook and Prognosis
Most people with Brugada syndrome never have dangerous rhythms and live full lives, especially with careful follow-up and trigger avoidance. Risk is higher after fainting with no warning, nighttime rhythms, or a family history of sudden death. When needed, tailored treatments—like an implantable defibrillator—lower life‑threatening risk.
Causes and Risk Factors
Brugada syndrome usually stems from inherited changes in heart‑rhythm genes (often autosomal dominant), though new mutations occur. Risk rises with male sex, Southeast Asian ancestry, family history, fever, certain medications or stimulants, alcohol, and electrolyte imbalances (e.g., low potassium).
Genetic influences
Genetics play a major role in Brugada syndrome. Many cases involve inherited changes—often in the SCN5A gene—that alter heart electrical signals, though not everyone with a variant develops symptoms. Testing can guide family screening, risk assessment, and some treatment choices.
Diagnosis
Brugada syndrome is diagnosed mainly by a characteristic ECG pattern, sometimes revealed with a sodium-channel blocker test, plus exclusion of look-alikes. Genetic diagnosis of Brugada syndrome can support care and guide family screening. Doctors may add imaging or electrophysiology studies.
Treatment and Drugs
Brugada syndrome care focuses on preventing dangerous heart rhythms and fainting. Many people are monitored closely, avoid fever and certain medicines that raise risk, and may take quinidine; some need an implantable defibrillator (ICD) for added protection. Regular follow-up guides adjustments.
Symptoms
Many people first notice fainting, pounding heartbeats, or nighttime gasping, often during rest or sleep. For some, early features of Brugada syndrome are subtle or even absent, while others have sudden, dramatic episodes. Features vary from person to person and can change over time. A family history of sudden unexplained death can also be a clue.
Fainting episodes: Brief loss of consciousness that often happens during rest or sleep. You may come to quickly but feel tired or confused afterward. In people with Brugada syndrome, fainting can be the first sign of a dangerous heart rhythm.
Heart palpitations: A racing, pounding, or fluttering heartbeat that starts and stops suddenly. It may come with lightheadedness or a feeling that your heart is skipping beats. In Brugada syndrome, palpitations can signal an unstable rhythm.
Dizziness or near-fainting: A sudden wave of lightheadedness or feeling like you might pass out. This can happen at rest, sometimes without warning.
Nighttime breathing changes: Gasping, labored breathing, or brief pauses in breathing can happen during sleep. These episodes may reflect a sudden change in heart rhythm at night. A bed partner might notice unusual breathing or abrupt movements.
Seizure-like spells: Brief shaking or jerking can occur when the brain gets less blood flow during a heart rhythm event. This can be mistaken for epilepsy. Episodes are often short and followed by quick recovery.
Sudden cardiac arrest: A sudden collapse with no pulse and no normal breathing. This is a medical emergency requiring immediate CPR and a defibrillator. It may be the first sign of Brugada syndrome in someone who had no prior symptoms.
Fever-triggered events: Fever of 38°C (100.4°F) or higher can trigger or worsen abnormal rhythms in Brugada syndrome. Palpitations, fainting, or seizure-like spells may appear during common illnesses. Nighttime events are especially common.
No symptoms: Many people with Brugada syndrome feel completely well day to day. Early features may be absent, and the condition is found only after a routine test or a family event.
ECG changes: Doctors may see a characteristic pattern on an electrocardiogram (ECG), sometimes only during a fever. This sign can come and go, even when you feel well.
Family history clues: Sudden unexplained death in a young relative, especially during sleep, is a key warning sign. Similar fainting or seizure-like episodes in close family can also point toward risk.
How people usually first notice
Types of Brugada syndrome
Brugada syndrome has recognized clinical patterns and genetic variants that can look a bit different from one another. Clinicians often describe them in these categories: the ECG pattern seen on testing, how symptoms present, and whether a known gene change is found. Not everyone will experience every type, and the balance of symptoms can shift over time. Understanding the main types of Brugada syndrome can help you and your clinician discuss risk and monitoring.
ECG Type 1
This classic pattern shows a marked “coved” ST elevation in specific chest leads on an ECG. It carries the highest concern for dangerous heart rhythms. Doctors may look for it spontaneously or after a carefully supervised medication challenge.
ECG Types 2–3
These show a “saddleback” or less typical ST changes that are not as specific as type 1. They may require additional testing to confirm Brugada syndrome. Some people convert to type 1 during fever or with certain medicines.
Spontaneous pattern
The type 1 ECG appears on its own during a routine ECG. This form is linked with a higher risk of fainting or sudden heart rhythm problems. Fever control and avoiding triggering drugs are especially important.
Drug‑induced pattern
The type 1 ECG appears only after a supervised medication challenge. Risk is generally lower than with a spontaneous pattern but not zero. Follow-up depends on symptoms, family history, and test results.
Symptomatic presentation
People have fainting, nighttime agonal breathing, or cardiac arrest due to fast ventricular rhythms. Symptoms don’t always look the same for everyone. For many, events are triggered by fever, heavy meals, or resting at night.
Asymptomatic presentation
People have the Brugada ECG pattern but no prior fainting or cardiac arrest. Risk is usually lower, yet careful evaluation and lifestyle guidance still matter. Shared decision-making helps tailor monitoring for different types of Brugada syndrome.
SCN5A‑positive
A confirmed disease‑causing change in the SCN5A gene is found. This variant can run in families and may be linked with more conduction slowing on ECG. Relatives may be offered testing to clarify their risk.
Genotype‑negative
No disease‑causing change is found on current genetic panels. Diagnosis relies on ECG pattern and clinical features. Family screening is still guided by the person’s ECG type and symptoms.
Did you know?
Certain SCN5A gene changes can weaken the heart’s sodium channels, leading to fainting, palpitations, or nighttime agonal breathing during fever or rest. Other variants in genes like CACNA1C or KCND3 can shift electrical flow, triggering dangerous arrhythmias or sudden cardiac arrest.
Causes and Risk Factors
Brugada syndrome often stems from inherited changes in a heart rhythm gene that affects the heart’s sodium channels. Key risk factors for Brugada syndrome include a family history of the condition or unexplained sudden death, being male, and Southeast Asian ancestry. Triggers that can unmask the pattern or raise risk include fever, some medicines, low potassium, alcohol, and cocaine. Doctors distinguish between risk factors you can change and those you can’t. Treating fevers promptly, avoiding risky drugs or alcohol, and considering genetic testing with a specialist can help you understand and lower your personal risk.
Environmental and Biological Risk Factors
Brugada syndrome raises the chance of dangerous heart rhythms in certain settings. Some risks are carried inside the body, others come from the world around us. Below are environmental and biological risk factors for Brugada syndrome, so you can spot and plan around common triggers.
Male sex: People assigned male at birth are more likely to show the ECG pattern and have serious rhythm events. Male hormones may play a role.
Southeast Asian ancestry: Brugada syndrome is found more often in people of Southeast Asian backgrounds, especially men. This reflects a higher observed susceptibility in these populations.
Age 30–50: Risk of serious rhythm problems tends to peak in mid-adulthood. Children and older adults can be affected, but events are less common.
Fever or infection: High body temperature can unmask the Brugada ECG pattern and raise the chance of dangerous rhythms. Treating fever promptly with fever-reducing medicines can lower this trigger.
Certain medications: Some heart rhythm drugs, antidepressants, antipsychotics, and certain anesthetic agents can reveal the ECG pattern or raise arrhythmia risk. Always tell clinicians you have Brugada syndrome before new medicines or procedures.
Surgery and anesthesia: Some anesthetic medicines and the stress of surgery can increase arrhythmia risk. Planning with the care team helps them choose safer options and close monitoring.
Electrolyte imbalance: Shifts in blood salts (electrolytes), especially low potassium, can provoke the ECG pattern or trigger dangerous rhythms. Imbalances may follow vomiting, diarrhea, or dehydration, so replacement and monitoring are important during illness.
Nighttime rest: Events often happen during sleep or at rest, when the nervous system leans toward rest-and-digest. This body state can make the heart’s electrical signals more likely to misfire in this condition.
Genetic Risk Factors
Many families notice Brugada syndrome runs in relatives because changes in heart rhythm genes can be passed down. Genetic testing for Brugada syndrome can help identify carriers and guide screening across the family. The most common known genetic cause is a harmful change in the SCN5A gene, which affects the heart’s sodium channel. Carrying a genetic change doesn’t guarantee the condition will appear.
SCN5A variants: Pathogenic changes in SCN5A are the leading known cause, found in about 20% to 30% of diagnosed families. They reduce the heart’s sodium current, which can set up the ECG pattern and raise the chance of dangerous rhythms.
Autosomal dominance: Inheritance is usually dominant, so each child of a carrier has a 50% (1 in 2) chance to inherit the variant. Family history of sudden cardiac death or a Brugada‑type ECG increases the likelihood a genetic variant is present.
Reduced penetrance: Not everyone with a Brugada‑related variant shows the ECG pattern or has symptoms. This means risk can differ widely between relatives who carry the same change.
Modifier genetics: Common differences in other heart channel genes can nudge sodium, calcium, or potassium activity up or down. These modifiers can influence who develops the Brugada pattern and the level of arrhythmia risk.
De novo changes: Sometimes the disease‑causing variant appears for the first time in a child, with no prior family history. In that situation, a parent’s future risk is usually low, though rare mosaicism can make recurrence possible.
Ancestry patterns: Brugada syndrome occurs more often in people with Southeast Asian or some Southern European ancestry, suggesting background genetic influences. Ancestry alone does not confirm or rule out a genetic change, but it can shape overall risk in a family.
Sex-related biology: People assigned male at birth more often show the Brugada ECG and experience events, likely due to differences in cardiac ion currents. This does not change inheritance, but it can affect who in a family expresses the condition.
Other genes rare: Changes in several other channel‑related genes have been reported, but most have limited or conflicting evidence. Results outside SCN5A should be interpreted cautiously by genetics and heart rhythm specialists.
Negative testing: Many with clear Brugada syndrome have no identifiable variant on current gene panels. A negative result does not rule out inherited risk, because some changes lie outside the regions most tests read.
Lifestyle Risk Factors
Brugada syndrome is a genetic heart rhythm condition; lifestyle habits do not cause it, but they can influence when abnormal rhythms are triggered and how safely you live with it. Practical choices around fever control, hydration, alcohol, substances, and exercise can lower the chance of dangerous arrhythmias. Below are lifestyle risk factors for Brugada syndrome and ways those habits can affect symptoms or complications.
Fever management: Fevers can unmask the Brugada ECG pattern and raise the risk of dangerous heart rhythms. Treat fevers promptly with antipyretics and fluids, and seek urgent care for high or persistent fever.
Alcohol intake: Binge or heavy drinking can precipitate arrhythmias in Brugada syndrome. Limiting alcohol and avoiding binges reduces the chance of nighttime or post-drinking rhythm events.
Hydration and electrolytes: Dehydration or low potassium/magnesium from sweating, vomiting, or crash diets can trigger arrhythmias. Maintain steady fluids and electrolytes, especially during illness, heat, or exercise.
Recreational stimulants: Cocaine, amphetamines, and similar stimulants can provoke dangerous ventricular arrhythmias in Brugada syndrome. Complete avoidance is the safest strategy.
OTC cold remedies: Some decongestants and certain OTC or herbal products can affect heart rhythm in Brugada syndrome. Check medications with a clinician or credible Brugada drug-avoidance lists before use.
Evening habits: Large late meals and heavy nighttime alcohol can heighten vagal tone during sleep, a time when Brugada events are more likely. Lighter evening eating and alcohol avoidance may reduce nocturnal arrhythmias.
Exercise and heat: Moderate activity is usually safe, but extreme exertion, saunas, or workouts in high heat can lead to dehydration and electrolyte loss that trigger arrhythmias. Favor steady, well-hydrated exercise and stop if you feel dizzy, faint, or have palpitations.
Risk Prevention
Brugada syndrome can’t be prevented at its source, but you can lower the chance of dangerous heart rhythm problems. There may be no early symptoms of Brugada syndrome, so prevention focuses on managing triggers, staying on top of check-ups, and planning ahead for emergencies. Prevention is about lowering risk, not eliminating it completely.
Fever control: Treat fevers promptly with acetaminophen/paracetamol and fluids, and avoid exercising when ill. Call your clinician if a fever is high (about 38–38.5°C or 100.4–101.3°F) or hard to bring down. People with Brugada syndrome may need closer monitoring during significant infections.
Medication safety: Avoid drugs known to trigger Brugada patterns or arrhythmias; ask your doctor or pharmacist before starting new medicines. Keep a written list or wallet card of medicines to avoid. Double-check over-the-counter and herbal products too.
Hydration and electrolytes: Stay well hydrated, especially in hot weather or during illness. Seek care for vomiting or diarrhea that can cause low potassium or magnesium, which may raise rhythm risk. Replenish fluids and salts as advised by your care team.
Alcohol and substances: Avoid binge drinking and limit alcohol, which can provoke abnormal rhythms in some people. Do not use cocaine, amphetamines, or other stimulants. If you need help cutting back, ask for support programs.
Regular cardiology follow-up: Attend scheduled visits and ECG checks to reassess your personal risk over time. Ask what to do if you faint, feel your heart racing, or have nighttime gasping or seizure-like episodes. Prevention works best when combined with regular check-ups.
Emergency action plan: Learn warning signs that need urgent care, such as fainting, racing heart, or breathing sounds during sleep. Share an action plan with family and coworkers, and consider first-aid/CPR training for loved ones. Keep emergency numbers and your diagnosis easy to find.
ICD discussion: If you’re at higher risk or have had a serious rhythm event, an implantable cardioverter-defibrillator (ICD) may prevent sudden death. Talk through benefits and possible downsides like shocks or device care. Revisit the decision as your situation changes.
Family screening: First-degree relatives should have an ECG and talk with a clinician about further testing. Genetic counseling and testing may clarify risks for relatives and guide monitoring. This helps find people who need trigger precautions even if they feel well.
Procedure planning: Tell surgeons, anesthetists, and dentists about Brugada syndrome before any procedure. Certain anesthetics or drops in body temperature or electrolytes can increase risk, so teams can adjust drugs and monitoring. Ask for careful temperature control during and after procedures.
Exercise with care: Most people can be active, which supports overall heart health. Skip strenuous workouts when you have a fever or are dehydrated, and cool down in hot weather. Choose activities that let you hydrate and rest as needed.
How effective is prevention?
Brugada syndrome is a genetic heart rhythm condition, so we can’t truly prevent having it, but we can lower the chance of dangerous heart rhythms. Avoiding triggers like high fevers, dehydration, and certain medications can meaningfully reduce risk. For many, a carefully chosen treatment plan—such as medication or an implantable cardioverter-defibrillator (ICD) when indicated—provides strong protection against life‑threatening arrhythmias. Regular follow‑up and family screening help catch problems early and keep risk as low as possible over time.
Transmission
Brugada syndrome is not contagious; you can’t catch it from someone or spread it through everyday contact or intimacy. Brugada syndrome usually runs in families and is most often passed from a parent to a child; each child of a parent with the condition has about a 1 in 2 (50%) chance of inheriting the gene change.
Some people who inherit the change never develop symptoms, but they can still pass it on to their children. Sometimes Brugada syndrome appears for the first time in a family because of a new genetic change. If you’re wondering how Brugada syndrome is inherited or the genetic transmission of Brugada syndrome in your family, genetic counseling and family screening can help clarify who may be at risk.
When to test your genes
Brugada syndrome is genetic, so consider testing if a close relative has it, you’ve had fainting or unexplained nighttime heart palpitations, or there’s sudden cardiac death under age 45 in the family. Testing also helps guide care if your ECG shows a Brugada pattern. Ask a cardiologist about ECG-first screening and genetic counseling.
Diagnosis
Brugada syndrome is usually found because of a suggestive heart tracing or a history of fainting or nighttime gasping. Doctors usually begin with an ECG when symptoms or a family history raise concern. The diagnosis of Brugada syndrome is based on a characteristic ECG pattern, supported by history and targeted tests. Sometimes the pattern appears only under certain conditions, like fever or specific medications, so testing may be repeated.
Standard ECG: A resting ECG looks for a telltale pattern in the right chest leads. When this clear pattern is present alongside symptoms or family history, it strongly supports the diagnosis.
High-lead placement: Placing the right chest ECG leads one or two spaces higher can reveal hidden changes. This simple adjustment can bring out the typical Brugada pattern.
Drug challenge: In a monitored setting, a short-acting medicine that blocks sodium channels may be given to unmask the ECG pattern. This test helps when the resting ECG is borderline or unclear.
History and family clues: Clinicians look for fainting, nighttime gasping, or past dangerous heart rhythms, plus any sudden deaths in close relatives. A detailed family and health history can help connect these clues.
Rule-out tests: Blood tests check electrolytes and other causes of ECG changes, and fever is addressed because it can trigger the pattern. Echocardiogram or cardiac MRI may be used to exclude structural heart disease.
Genetic testing: A gene change is found in only a portion of people with Brugada syndrome, so a normal result does not rule it out. When a disease-causing change is found, it can guide family screening and counseling.
Monitoring rhythms: Ambulatory ECG monitors or hospital telemetry can capture abnormal beats or brief rhythm storms that symptoms hint at. These recordings support risk assessment and next steps.
Electrophysiology study: Some centers use an invasive test to map the heart’s electrical system and check how easily dangerous rhythms start. Results can inform risk discussions, though it is not required for every diagnosis.
Stages of Brugada syndrome
Brugada syndrome does not have defined progression stages. It’s a heart rhythm condition where the risk of dangerous rhythms can be present at any time, the ECG pattern may come and go, and there isn’t a predictable, step-by-step worsening. Different tests may be suggested to help confirm the diagnosis, including an electrocardiogram (ECG), sometimes a medication challenge, and a review of symptoms like fainting or brief blackouts—early symptoms of Brugada syndrome—plus any family history of sudden death. Ongoing care often includes periodic ECGs or wearable heart monitors, and in some cases genetic testing to clarify risks and guide family screening.
Did you know about genetic testing?
Did you know genetic testing can help explain why Brugada syndrome runs in some families and identify who else may be at risk before symptoms appear? Finding a disease‑causing variant can guide safer choices—like avoiding certain medications, planning heart monitoring, or considering an implantable defibrillator if needed. It also helps relatives decide if they should be checked, so everyone can take preventive steps with their cardiology team.
Outlook and Prognosis
Looking at the long-term picture can be helpful. For many people with Brugada syndrome, the outlook depends on whether they’ve ever fainted, had a dangerous heart rhythm, or carry certain high‑risk ECG patterns. People who have no symptoms and a lower‑risk ECG often live normal lives with careful follow‑up. In contrast, those with prior fainting from an arrhythmia or cardiac arrest face a higher chance of another serious event, especially at night or during fevers.
Prognosis refers to how a condition tends to change or stabilize over time. The main health risk in Brugada syndrome is a sudden, fast heart rhythm that can lead to collapse; this is why some people receive an implantable cardioverter‑defibrillator (ICD). When an ICD is recommended and routine triggers are managed—like treating fevers quickly and avoiding risky medications—long‑term survival is generally good. Reported mortality is highest in those who have already had a cardiac arrest; in lower‑risk, symptom‑free groups, the annual risk of life‑threatening rhythm problems is much lower.
Many people ask, “What does this mean for my future?”, especially when thinking about early symptoms of Brugada syndrome such as nighttime fainting or unexplained seizures that turn out to be heart‑related. With ongoing care, many people maintain full work, family life, and exercise within advised limits. Talk with your doctor about what your personal outlook might look like, including whether you need an ICD, how to manage fevers, medication choices, and how often to check in.
Long Term Effects
Brugada syndrome is a lifelong heart rhythm condition where the main concern is the risk of dangerous, fast rhythms from the lower chambers of the heart. Long-term effects vary widely, and some people remain stable for decades while others face repeated rhythm events. People sometimes search for early symptoms of Brugada syndrome, but the long-term picture focuses more on patterns of arrhythmia risk over time. Risk can change across life stages and may be influenced by factors like sex and age.
Ventricular arrhythmias: The core long-term risk is fast, unstable rhythms from the heart’s lower chambers that can cause fainting or sudden cardiac arrest. This risk in Brugada syndrome can be higher in adult males and may cluster around midlife.
Nighttime breathing events: Some people experience gasping or abnormal breathing during sleep when an arrhythmia strikes. In Brugada syndrome, these episodes can precede fainting or cardiac arrest.
Conduction system changes: Over years, a subset develop slowing in the heart’s electrical pathways, leading to long pauses or heart block. This can cause lightheadedness, near-fainting, or fatigue in daily activities. Doctors may track these changes over years to see how they evolve.
Atrial arrhythmias: Brugada syndrome raises the chance of atrial fibrillation or flutter, which may feel like pounding or irregular heartbeats. Long-standing atrial fibrillation can increase the risk of clot-related stroke if untreated.
ECG pattern shifts: The characteristic Brugada ECG pattern can appear, fade, and return over time. Fever, certain medications, or other stressors may unmask the pattern years after a normal tracing.
Trigger sensitivity: People with Brugada syndrome retain lifelong sensitivity to fever and some substances that can provoke arrhythmias. This vulnerability can persist even when everyday ECGs look normal.
Family implications: Because Brugada syndrome often runs in families, close relatives may share the underlying trait and risk patterns. Expression can differ widely among family members across childhood, adulthood, and aging.
How is it to live with Brugada syndrome?
Living with Brugada syndrome often means planning for the unexpected while trying to keep life feeling normal. Many people feel well day to day, but they carry the weight of knowing a dangerous heart rhythm can happen suddenly, so they learn their triggers, keep fevers treated promptly, review medications for safety, and follow up regularly with their care team; some live with an implanted defibrillator and the mixed relief and worry that can bring. Family members may share screening decisions and, at times, the anxiety of a hereditary condition, but clear emergency plans, medical ID, and honest conversations can help everyone feel prepared rather than afraid.
Treatment and Drugs
Brugada syndrome treatment focuses on preventing dangerous heart rhythms and sudden cardiac arrest. The mainstay for people at higher risk is an implantable cardioverter-defibrillator (ICD), a small device placed under the skin that can quickly correct a life‑threatening rhythm if it occurs. Doctors sometimes prescribe medicines to stabilize the heart’s electrical signals, and may advise avoiding certain drugs, excessive alcohol, heavy meals at night, and high fevers; treating fever promptly with acetaminophen/paracetamol and fluids is important. Your doctor may suggest periodic checkups, family screening, and guidance on exercise, travel, and procedures that need anesthesia, since some medicines can raise risk. Not every treatment works the same way for every person, so your care team will tailor the plan based on your symptoms, ECG pattern, personal and family history, and test results.
Non-Drug Treatment
For people with Brugada syndrome, day-to-day steps can lower risk between clinic visits. Non-drug treatments often lay the foundation for safety and peace of mind. Recognizing early symptoms of Brugada syndrome—like fainting without warning, especially during rest—can help you and your care team act quickly. Plans are tailored to your personal and family history, ECG pattern, and overall risk level.
ICD evaluation: An implantable cardioverter-defibrillator can stop life-threatening rhythms within seconds. Doctors consider it for those with prior cardiac arrest, fainting with high-risk features, or high-risk ECG findings. Decisions balance benefits, potential shocks, and lifestyle.
Fever control: Fever can trigger dangerous heart rhythms in Brugada syndrome. Use rapid cooling measures, drink fluids, and seek urgent care for high or persistent fever. Contact your care team early during any illness.
Medication and substances: Some prescription, over-the-counter, and recreational drugs can raise risk by changing heart signals. Avoid risky medicines, cocaine, and heavy alcohol, and check trusted do-not-use lists before starting anything new. Make sure every clinician you see knows your diagnosis.
Electrolyte balance: Low potassium or dehydration can make abnormal rhythms more likely. Stay well hydrated, especially in hot weather or during illness, and replace fluids and salts as advised. Get medical help for ongoing vomiting or diarrhea.
Exercise guidance: Most people can stay active with sensible precautions. Avoid extreme overheating, dehydration, and sudden all-out efforts without specialist clearance. A sports or heart specialist can tailor safe activity for you.
Genetic counseling: Close relatives may share the same risk even if they feel well. Genetic counseling can explain testing options and ECG screening for family members. Sharing results helps relatives get timely checks.
Regular follow-up: Scheduled visits track ECG changes, triggers, and any new symptoms. Remote or in-clinic monitoring helps fine-tune your safety plan. Bring notes about fainting spells, palpitations, or night-time events.
Emergency action plan: Learn when to call emergency services for fainting, gasping, or seizure-like episodes. Teach family CPR and consider access to an AED at home or in the community. Carry a diagnosis card and a medication-avoidance list.
Catheter ablation: In expert centers, targeting the faulty electrical area can reduce recurrent dangerous rhythms in selected people. It is considered if shocks recur or other measures are not enough. Your team will discuss potential benefits and risks.
Mental health support: Living with uncertainty can fuel worry, insomnia, or low mood. Supportive therapies can reduce anxiety and make day-to-day routines easier to follow. Counseling, peer groups, and stress-management skills are common options.
Did you know that drugs are influenced by genes?
Medicines that affect heart rhythm can trigger dangerous electrical changes in people with Brugada syndrome, and inherited variants in sodium-channel genes help explain who is most sensitive. Pharmacogenetic testing and careful drug selection with a cardiologist can reduce these risks.
Pharmacological Treatments
Medication in Brugada syndrome focuses on reducing dangerous heart rhythms and managing triggers like fever, especially during high‑risk periods. Not everyone responds to the same medication in the same way. Drugs are used when an implantable defibrillator isn’t suitable, to reduce shocks, or for acute treatment of Brugada syndrome electrical storm in the hospital. Your cardiology team will match choices to your symptoms, ECG pattern, and risk level.
Quinidine therapy: Quinidine or hydroquinidine can stabilize the heart’s electrical signaling and reduce episodes of dangerous rhythms. It may be used long term for recurrent fainting or ICD shocks, or when an ICD isn’t an option. Side effects can include diarrhea or ringing in the ears, so dosing is monitored closely.
Isoproterenol infusion: In the ICU, intravenous isoproterenol (isoprenaline) can stop repeated abnormal rhythms during an electrical storm. It raises the heart rate and strengthens protective currents in the heart’s cells. This is a short‑term hospital treatment with continuous heart monitoring.
Cilostazol option: Cilostazol may help lessen arrhythmias and improve the ECG pattern in some people when quinidine isn’t tolerated or available. This is an off‑label approach guided by specialists. Headache or palpitations can occur, and it’s avoided in severe heart failure.
Fever control: Acetaminophen (paracetamol) or ibuprofen to bring down fever can lower arrhythmia risk in Brugada syndrome. Treat fevers promptly and stay well hydrated during infections. Seek urgent care for fainting, severe palpitations, or persistent high fever.
Genetic Influences
Brugada syndrome often has a genetic basis, most commonly involving a change in a gene that controls a heart sodium channel. Having a gene change doesn’t always mean you will develop the condition. This pattern is typically passed from parent to child, so if a parent carries the change, each child has about a 50% chance of inheriting it.
That said, testing finds a clear gene change in only a portion of people with Brugada syndrome, and features can vary widely even within the same family. Other factors—like certain medications, fever, and sex differences—can influence whether the ECG pattern appears or symptoms occur. Genetic testing can help identify who else in the family should be checked, and while results can’t predict the timing or early symptoms of Brugada syndrome, they do guide follow-up and screening plans.
How genes can cause diseases
Humans have more than 20 000 genes, each carrying out one or a few specific functiosn in the body. One gene instructs the body to digest lactose from milk, another tells the body how to build strong bones and another prevents the bodies cells to begin lultiplying uncontrollably and develop into cancer. As all of these genes combined are the building instructions for our body, a defect in one of these genes can have severe health consequences.
Through decades of genetic research, we know the genetic code of any healthy/functional human gene. We have also identified, that in certain positions on a gene, some individuals may have a different genetic letter from the one you have. We call this hotspots “Genetic Variations” or “Variants” in short. In many cases, studies have been able to show, that having the genetic Letter “G” in the position makes you healthy, but heaving the Letter “A” in the same position disrupts the gene function and causes a disease. Genopedia allows you to view these variants in genes and summarizes all that we know from scientific research, which genetic letters (Genotype) have good or bad consequences on your health or on your traits.
Pharmacogenetics — how genetics influence drug effects
If you live with Brugada syndrome, certain medicines can raise the risk of dangerous heart rhythms, so drug choices matter. Changes in the heart’s sodium channel—often from a variant in the SCN5A gene—can make drugs that block that channel have a stronger effect, sometimes bringing out the Brugada ECG pattern or triggering arrhythmias. This is why some heart‑rhythm medicines, certain antidepressants and antipsychotics, and some anesthetics are flagged for caution or avoidance; your clinicians will consult trusted, up-to-date lists of medications to avoid with Brugada syndrome. Genes can influence how quickly you process certain drugs, which may change how strong an effect they have. In day‑to‑day care, genetic testing is most helpful for confirming Brugada syndrome and guiding family screening; it can also alert your team to drug sensitivities, but there aren’t broad, dose‑by‑gene rules specific to Brugada yet. Working from your history and ECG results, your care team may favor options like quinidine when appropriate, plan anesthesia with specialists, and focus on fever control so medicines are used as safely as possible.
Interactions with other diseases
Fever from infections like the flu or COVID-19 can unmask ECG changes in Brugada syndrome and raise the chance of dangerous heart rhythms, so treating a fever promptly is important. Stomach bugs that cause vomiting or diarrhea can lead to dehydration and electrolyte shifts, which may also increase rhythm risk; similarly, heavy alcohol use or stimulant drugs can make rhythms more unstable. Certain diseases may “overlap,” meaning someone can have Brugada syndrome along with another heart rhythm condition (such as long QT tendencies), and this can change how doctors plan monitoring and treatment. If coronary artery disease, heart inflammation (myocarditis), or heart failure are present, the combined stress on the heart can further lower the threshold for arrhythmias. Medicines used for other illnesses—including some antidepressants, antipsychotics, anesthetics, and sodium‑channel–blocking drugs—can interact with Brugada syndrome, so bring a full medication list to every visit and ask before starting anything new. For some, early symptoms of Brugada syndrome—such as fainting during a fever—show up only when another condition is active, which is why coordinated care and clear safety plans matter.
Special life conditions
You may notice new challenges in everyday routines. During pregnancy, most people with Brugada syndrome do well, but fever and certain medicines used in labor can raise the risk of heart rhythm problems, so teams often plan ahead and avoid triggers. In children, Brugada syndrome may first show up during a high fever, so prompt fever control and a low threshold to seek care are important; doctors sometimes recommend an electrocardiogram after a concerning fainting spell. For older adults, other heart or kidney conditions and medication changes can unmask the pattern, so regular review of prescriptions—including antibiotics, mood medicines, and some pain or anesthesia drugs—matters.
Active athletes can usually exercise, but very high‑intensity efforts, overheating, dehydration, or stimulant supplements may increase risk; a tailored plan helps people train safely and know when to pause. Travel or infections that bring fevers need quick treatment with antipyretics and hydration, and having an emergency plan can reduce stress. Loved ones may notice brief blackouts or nighttime gasping; sharing these observations with your care team can guide monitoring. Talk with your doctor before pregnancy, surgery, or new sports goals to adjust medicines, discuss anesthesia choices, and decide whether devices like an ICD or a home automated external defibrillator make sense for your situation.
History
Throughout history, people have described sudden nighttime collapses in otherwise healthy adults, often after a fever or during sleep. Families told stories of an uncle who died in his 30s, or a cousin who fainted after a mild illness, with no clear cause found on routine exams. These lived experiences hinted at a heart rhythm problem long before it had a name.
From early theories to modern research, the story of Brugada syndrome shows how careful observation and better testing can change care. For years, doctors saw patterns—fainting, seizure-like episodes, or sudden cardiac arrest with a normal-looking heart—but standard tests often looked fine. In some regions of Southeast and East Asia, similar events were reported more often, and community accounts helped clinicians recognize that fever and nighttime rest could trigger dangerous rhythms.
In 1992, researchers described a distinct ECG pattern linked to these events, and the condition became known as Brugada syndrome. Initially understood only through symptoms and a characteristic tracing on the heart’s electrical recording, later studies connected the dots between the ECG pattern, fainting spells, and risk of life-threatening arrhythmias. As ECG testing improved, doctors learned that the pattern can come and go, and that certain medicines or a fever may unmask it.
Advances in genetics added another layer. In the late 1990s, scientists identified changes in a gene that affects sodium flow in heart cells, helping explain why the heart’s electrical system can misfire. Not everyone with Brugada syndrome has a detectable gene change, and not everyone with a gene change develops symptoms, but this work clarified why it can run in families and why triggers matter.
Over time, descriptions became more precise. What began as case reports of sudden, unexplained deaths evolved into a defined syndrome with clear diagnostic criteria, including how to confirm the ECG pattern and how to use drug challenges safely in a monitored setting. Clinicians also recognized that risk varies: some people live for decades with only an unusual ECG, while others experience early symptoms of Brugada syndrome such as fainting or palpitations, especially during fever.
These historical steps reshaped treatment. The focus shifted from searching for structural heart disease to preventing dangerous rhythms. Implantable defibrillators became a key option for those at higher risk, while careful fever management and avoiding certain drugs reduced preventable triggers. Family screening moved to the forefront so relatives could be checked even if they felt well.
Knowing the condition’s history helps explain today’s approach: watchful ECG interpretation, attention to fever, thoughtful use of medications, and tailored care guided by personal and family risk. The path from scattered reports to a named diagnosis has directly improved safety for people living with Brugada syndrome and their families.