Risk stratification and criteria for diagnosis in Brugada syndrome: current status and developing

Management of patients with Brugada syndrome depends on risk stratification. To date, implantation of a car-dioverter-defibrillator is the most appropriate therapy for the prevention of sudden death in patients with high-risk Brugada syndrome with interrupted heart failure and/or hemodynamically significant ventricular arrhythmias. Patients only with drug-induced changes in the electrocardiogram and without any other clinical manifestations are at a very low risk of sudden cardiac death. Patients with a history of syncope are at intermediate risk. Their risk stratification depends primarily on the alleged cause of loss of consciousness (arrhythmic or non-arrhythmic). However, most patients with Brugada syndrome are asymptomatic. For them, the generally accepted approach to assessing arrhythmic risk is not available; accordingly, indications for implantation of a cardioverter-defibrillator remain unclear. At the same time, cardiac arrest may be the first and only clinical manifestation of the disease. Therefore, risk stratification tools are needed for all patients with Brugada syndrome. So, the identification of factors that can predict the risk of arrhythmic events in Brugada syndrome has been the focus of research attention in recent years. This also leads to a constant interest in updating the criteria for diagnosing the disease, and debate is ongoing regarding the need to include additional identifiable clinical signs that go beyond the characteristic changes in the electrocardiogram. This review discusses current data on improving the diagnosis and risk stratification of Brugada syndrome, includ-ing the latest important refinements proposed at the Shanghai Conference in 2016.