Amitriptyline, nortriptyline, or other tricyclic antidepressants
Cocaine (always strictly avoid)
Lifestyle instructions
Avoid excessive alcohol
Intoxication can trigger dangerous heart rhythms
Avoid large meals especially late at night
Large meals increase vagal tone and can trigger events
Stay well hydrated
Dehydration and electrolyte imbalance increase risk
Avoid cannabis
Associated with arrhythmic events in Brugada syndrome
Family steps
First-degree relatives should be screened
Parents, siblings, and children should have an ECG
Refer to cardiologist or electrophysiologist for evaluation
Family members should know CPR
Consider having an automated external defibrillator (AED) in the home
Register your home AED with local emergency services
Genetic counseling
Discuss family planning implications with a genetic counselor
Return to emergency immediately if
You faint or lose consciousness especially during rest or sleep
You feel your heart racing or pounding followed by near-faint
Your ICD delivers a shock
Fever above 38 C that does not respond to acetaminophen within 1-2 hours
A family member witnesses you making gasping or abnormal breathing sounds during sleep
Follow-up required
Electrophysiology appointment within 1-2 weeks of this visit
Risk assessment and possible further testing
Annual cardiology follow-up for all Brugada syndrome patients
ICD device check every 3-6 months if device implanted
References
Guidelines and key sources
2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death
Al-Khatib SM, Stevenson WG, Ackerman MJ, et al.
Journal of the American College of Cardiology. 2018
Primary guideline for BrS risk stratification and ICD indications
EHRA/HRS/APHRS/LAHRS Expert Consensus Statement on Genetic Testing for Cardiac Diseases
Wilde AAM, Semsarian C, Marquez MF, et al.
Heart Rhythm. 2022
Guidance on genetic testing and cascade family screening
Brugada Syndrome: JACC State-of-the-Art Review
Brugada J, Campuzano O, Arbelo E, Sarquella-Brugada G, Brugada R.
Journal of the American College of Cardiology. 2018
Comprehensive clinical review including quinidine and ablation evidence
HRS/EHRA/APHRS Expert Consensus Statement on Inherited Primary Arrhythmia Syndromes
Priori SG, Wilde AA, Horie M, et al.
Heart Rhythm. 2013
Foundational consensus for management of BrS and related channelopathies
Brugada Syndrome. GeneReviews
Brugada R, Campuzano O, Sarquella-Brugada G, et al.
NCBI GeneReviews. 2022
Genetic basis, cascade screening, and long-term management
2021 PACES Expert Consensus Statement on Cardiovascular Implantable Electronic Devices in Pediatric Patients
Shah MJ, Silka MJ, et al.
Heart Rhythm. 2021
Pediatric ICD indications including BrS
2024 HRS Expert Consensus Statement on Arrhythmias in the Athlete
Lampert R, Chung EH, Ackerman MJ, et al.
Heart Rhythm. 2024
Sports participation considerations for BrS patients
Drug-Induced Arrhythmias: AHA Scientific Statement
Tisdale JE, Chung MK, Campbell KB, et al.
Circulation. 2020
Evidence base for contraindicated drug list in BrS
Brugada Syndrome: JACC Clinical Electrophysiology
Krahn AD, Behr ER, Hamilton R, et al.
JACC Clinical Electrophysiology. 2022
Updated diagnostic and management review
Patients With Brugada Syndrome and Implanted Cardioverter-Defibrillators: Long-Term Follow-Up
Hernandez-Ojeda J, Arbelo E, Borras R, et al.
Journal of the American College of Cardiology. 2017
Long-term ICD outcomes including inappropriate shock data
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.