Indication of ICD in Brugada syndrome

Without question, implantable cardioverter–defibrillators (ICDs) are required in symptomatic Brugada patients with an aborted sudden cardiac death and/or documented ventricular fibrillation (VF) for the so‐called secondary prevention of sudden cardiac death, even if there is a possibility of complications and inappropriate shocks. On the other hand, it is difficult to identify high‐risk patients requiring ICD placement among the Brugada syndrome patients with syncope and those asymptomatic. The incidence of de novo VF in asymptomatic patients with Brugada syndrome is very low. However, the cardiac events caused by this syndrome are very serious and lethal. Currently, a spontaneous type 1 ECG and the presence of at least two multiparametric risk factors, including syncope, a family history, and a positive electrophysiological (EP) study, are the only criteria used to correctly identify patients requiring ICD placement (Class IIa in the Japanese guidelines). Further investigation and the observation of the long‐term prognosis in asymptomatic Brugada syndrome patients are necessary to define criteria for accurately identifying high‐risk patients.