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Health condition · Clinically reviewed

Brugada syndrome, the sodium channel, the ECG, and the family behind it.

An inherited electrical condition of an otherwise normal heart. The good news: careful ECG work, a fever plan, drug awareness and, where needed, an ICD change the story completely.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a UK cardiac electrophysiologist before publication.

  • 02

    Sourced from guidance

    Checked against ESC 2022 ventricular arrhythmia guidance, HRS/EHRA/APHRS/LAHRS consensus and UK inherited cardiac conditions services.

  • 03

    Current for 2026

    Reflects modern practice including the Shanghai risk score, subcutaneous ICDs and epicardial substrate ablation.

Key facts

Brugada syndrome at a glance.

A short primer on what it is, who it affects and how modern UK inherited cardiac conditions services approach it.

  • What it is

    An inherited cardiac sodium channelopathy that raises the risk of polymorphic VT and ventricular fibrillation, most often during sleep or fever.

  • Genetics

    Autosomal dominant with variable penetrance. SCN5A loss-of-function accounts for around 20 to 30 per cent, with more than 20 other genes described.

  • Who it affects

    Higher prevalence in Southeast Asia. Men are affected roughly eight times more often than women, with peak arrhythmic events in the 30s and 40s.

  • The classic story

    A family history of sudden cardiac death under 45, or a nocturnal cardiac arrest with agonal breathing during sleep (SUNDS).

  • Diagnostic clue

    A type 1 coved ST elevation of 2 mm or more in leads V1 to V2, either spontaneously or unmasked by an ajmaline or flecainide challenge.

  • The main defence

    An implantable cardioverter defibrillator for anyone with cardiac arrest, arrhythmic syncope or high-risk features. Quinidine has a defined role.

Why this guide matters

A treatable diagnosis, when it is picked up.

Brugada does its damage silently. Three things shift the odds: the right ECG, the right family conversation and the right plan.

  • The right ECG in the right place

    Adding high V1 and V2 leads in the 2nd and 3rd intercostal spaces meaningfully improves detection of the type 1 pattern.

  • A family, not an individual, diagnosis

    Cascade ECG and, where appropriate, genetic testing of first-degree relatives is a core part of care, not an optional extra.

  • ICDs and quinidine save lives

    For survivors of arrest, arrhythmic syncope or high-risk features, an ICD is the intervention that consistently changes outcomes.

How the diagnosis is made

From a suspicious ECG to a settled plan.

The steps a UK cardiologist and inherited cardiac conditions team will normally take, in order.

  1. 01

    Assessing

    History and family tree

    Detailed personal history of syncope, nocturnal breathing, palpitations, and a three-generation family tree focused on sudden death under 45.

  2. 02

    Assessing

    12-lead ECG (standard and high)

    Standard ECG plus repeat with V1 and V2 in the 2nd and 3rd intercostal spaces, which increases sensitivity for the type 1 pattern.

  3. 03

    Assessing

    Echocardiogram

    To exclude structural heart disease. A normal echo supports a primary electrical diagnosis rather than an inherited cardiomyopathy.

  4. 04

    Confirming

    Ambulatory and event monitoring

    Holter, ambulatory ECG or implantable loop recorder to catch arrhythmias behind syncope or nocturnal symptoms.

  5. 05

    Confirming

    Ajmaline or flecainide challenge

    A sodium channel blocker provocation test in a specialist EP centre, with defibrillator on standby, to unmask a type 1 pattern from a suspicious type 2 or 3.

  6. 06

    Confirming

    Genetic testing and cascade

    SCN5A and a Brugada gene panel, with genetic counselling. First-degree relatives are offered cascade ECG and, if a variant is found, genetic testing.

  7. 07

    Planning

    Risk stratification and MDT

    Shanghai score, selective EP study with programmed stimulation, and a multidisciplinary inherited cardiac conditions clinic decide on ICD and lifestyle plan.

Typical timeline: a suspicious ECG to a full risk plan in weeks, not months.

Symptoms

How Brugada actually shows up.

Most people are asymptomatic. The features below are the ones that should not be ignored, alongside the family history that often makes sense of them.

  • Often no symptoms at all

    Most people are picked up on an incidental ECG done for another reason, or through family screening after a relative is diagnosed.

  • Syncope, especially at rest

    Blackouts without a clear trigger, particularly at night or during sleep, warrant urgent cardiology review rather than reassurance.

  • Nocturnal agonal breathing

    Loud, gasping or laboured breathing during sleep reported by a partner can be the only warning sign of a self-terminating arrhythmia.

  • Palpitations

    Sustained or unusual palpitations, especially with light-headedness, deserve an ECG and ambulatory monitoring.

  • Aborted cardiac arrest

    A survived VF arrest, especially in a young adult with a structurally normal heart, is a red flag for Brugada and other channelopathies.

  • Fever-triggered events

    Symptoms that appear during a febrile illness are a well-recognised pattern and a strong prompt for a resting ECG during the fever.

  • Family history of sudden death

    A first-degree relative with unexplained sudden death under 45, or a known Brugada diagnosis, is enough on its own to justify screening.

  • Red flag - spontaneous type 1 ECG

    A spontaneous type 1 pattern (without a drug challenge) carries a higher arrhythmic risk than a drug-unmasked pattern and needs specialist review.

Treatment

How Brugada is managed in the UK.

Lifestyle and drug awareness for everyone, ICDs for high-risk patients, quinidine and ablation for recurrent arrhythmias, and a family plan for the people who share your genes.

  • Lifestyle and drug avoidance

    Avoid the drugs listed on Brugadadrugs.org, treat fever early with paracetamol and tepid sponging, and moderate alcohol, cocaine, cannabis and heavy meals.

  • Fever protocol

    A written plan to treat any temperature above 38.5 °C promptly, with a low threshold for a same-day ECG and specialist advice during febrile illness.

  • Implantable defibrillator

    ICD (often subcutaneous S-ICD) is a Class I indication for survivors of cardiac arrest and for arrhythmic syncope with a spontaneous type 1 ECG.

  • Quinidine

    A Class Ia antiarrhythmic that paradoxically reduces VF episodes in Brugada. Useful for ICD storms, when ablation has failed, and where an ICD is declined.

  • Isoproterenol infusion

    The acute treatment of choice for a Brugada electrical storm, delivered in cardiac intensive care while longer-term options are planned.

  • Catheter ablation

    Epicardial substrate ablation over the anterior right ventricular outflow tract is an emerging option in specialist UK EP centres for recurrent VF or ICD storms.

  • Family cascade screening

    First-degree relatives are offered an ECG, genetic counselling and, where a family variant is known, cascade genetic testing through an ICC service.

  • DVLA, sport and MDT follow-up

    Group 1 driving usually restricted for six months after syncope, Group 2 more restricted. Sport is individualised with input from a specialist MDT.

Specialist UK inherited cardiac conditions and EP centres for Brugada include King's College Hospital, Barts Heart Centre, St Thomas', Royal Papworth, Manchester, Sheffield, Newcastle and Leeds. Patient support is available from Cardiomyopathy UK and SADS UK.

What this guide is based on

The sources behind every claim on this page.

International society guidance, UK inherited cardiac conditions practice and dedicated patient organisations, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your cardiologist and inherited cardiac conditions team know your ECG, your family history and your circumstances. If in doubt, get seen.

  • European Society of Cardiology. 2022 Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death.

  • HRS/EHRA/APHRS/LAHRS. Expert consensus statement on the state of genetic testing for cardiac diseases.

  • Shanghai Brugada Syndrome Score (Antzelevitch et al.). J-Wave Syndromes Expert Consensus Conference Report.

  • Brugadadrugs.org. Curated list of drugs to be avoided in Brugada syndrome.

  • Cardiomyopathy UK and SADS UK. Patient information on inherited arrhythmia syndromes.

  • DVLA. Assessing fitness to drive: a guide for medical professionals (cardiovascular disorders section).

Red flags

When Brugada needs urgent attention.

Most of the day-to-day of Brugada is quiet. These are the moments that are not, and where an inherited cardiac conditions team should be involved.

  • Aborted sudden cardiac death

    Any survivor of ventricular fibrillation with a Brugada ECG needs urgent inherited cardiac conditions and EP review, and almost always an ICD.

  • Arrhythmic syncope

    Blackouts at rest, at night, or with prodrome-free collapse in someone with a Brugada pattern should not be dismissed as vasovagal.

  • Spontaneous type 1 ECG

    A spontaneous coved ST elevation of 2 mm or more in V1 to V2 confers higher risk than a drug-unmasked pattern and changes the ICD conversation.

  • Fever above 38.5 °C

    Fever can unmask arrhythmias in Brugada. Treat temperature promptly, seek early review, and consider an ECG during the illness.

  • Nocturnal agonal breathing

    Gasping or laboured breathing during sleep, especially witnessed by a partner, may signal a self-terminating arrhythmia and needs cardiology review.

  • Family history of sudden death under 45

    Any first-degree relative with unexplained sudden death, drowning or single-vehicle road accident deserves ICC assessment.

  • Contraindicated drug started in error

    Sodium channel blockers, tricyclic antidepressants, lithium and some anaesthetic agents can provoke arrhythmias. Cross-check every new medicine.

  • ICD storm

    Three or more appropriate shocks in 24 hours is a cardiological emergency. Isoproterenol, quinidine and specialist EP input are needed.

  • Cocaine or heavy alcohol binge

    Both can unmask arrhythmias in Brugada and are a common trigger for a first presentation. Honest history and harm-reduction advice matter.

Living with it

A serious diagnosis, with a clear routine.

Four habits change how it feels to live with Brugada: treat fever early, cross-check every new medicine, bring your relatives in, and lean on the specialist support that already exists.

A quiet reminder

Small, boring habits do the heavy lifting.

A paracetamol packet at home, a medicines list on your phone, and a family that has had their ECGs done. The unremarkable things are the ones that save lives here.

  1. 01 Fever

    Treat temperature early

    Keep paracetamol at home, treat any fever above 38.5 °C promptly, and seek same-day advice if you feel unwell or unusually breathless.

  2. 02 Drugs

    Check every new medicine

    Show your Brugada diagnosis at every appointment and cross-check new medicines against the Brugadadrugs.org list, including over-the-counter ones.

  3. 03 Family

    Bring your relatives in

    First-degree relatives deserve an ECG and, where appropriate, cascade genetic testing. Early information changes outcomes.

  4. 04 Support

    You are not alone

    Cardiomyopathy UK, SADS UK and specialist inherited cardiac nurses provide practical, emotional and family support throughout your care.

Frequently asked

Everything we get asked about Brugada.

Quick answers on ECGs, genetics, triggers, ICDs and the everyday questions about driving, work and sport.

  • What is Brugada syndrome?

    Brugada syndrome is an inherited disorder of the cardiac sodium channel that raises the risk of polymorphic ventricular tachycardia and ventricular fibrillation. Events often happen at rest or during sleep, and can present as sudden cardiac death in an otherwise healthy young adult with a structurally normal heart.

  • How is it inherited?

    Most cases are autosomal dominant with variable penetrance, which means a parent, sibling or child of an affected person has a one in two chance of carrying the variant but may never develop symptoms. SCN5A is the best-known gene, but more than 20 others have been described. Genetic counselling and cascade family screening are a central part of care.

  • What does the diagnostic ECG look like?

    The diagnostic pattern is a coved ST elevation of 2 mm or more with a negative T wave in leads V1 to V2, known as type 1. A saddle-back pattern (type 2) or a smaller elevation (type 3) is suspicious rather than diagnostic and often prompts an ajmaline or flecainide provocation test in a specialist EP centre.

  • What can trigger an arrhythmia?

    Common triggers include fever, sodium channel blocking drugs (such as flecainide, tricyclic antidepressants and lithium), cocaine, heavy alcohol, large meals, sleep and electrolyte disturbances such as low or high potassium. A written personal action plan for fever and drugs to avoid is a core part of management.

  • Do I need an implantable defibrillator?

    An ICD, often a subcutaneous device, is a Class I recommendation for survivors of cardiac arrest and for arrhythmic syncope with a spontaneous type 1 pattern. In asymptomatic people the decision is individualised and uses the Shanghai score, family history, spontaneous versus drug-induced ECG and, in selected cases, an electrophysiology study.

  • Can I still exercise, drive and work?

    Most people can lead a full life. Extreme endurance exercise is generally discouraged and sport is individualised with your specialist team. DVLA rules restrict driving for around six months after arrhythmic syncope for Group 1 and more strictly for Group 2. Work restrictions depend on your role and are decided with your cardiologist and occupational health.

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