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cardio.brugada-syndrome.chronic.v1

Brugada syndrome (chronic ambulatory — SCD risk stratification)

cardiologychronicadultoutpatienttransition
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Brugada syndrome chronic — SCD-risk-stratification-first: ICD by symptom/spontaneous-type-1 risk, quinidine for VF recurrence/ICD storm/ICD-declined, epicardial RVOT ablation for refractory storm, aggressive fever management + brugadadrugs.org avoidance + genetic cascade. Manifest points at existing sibling cardio.post-arrest.core.v1.ts per nearest-ID precedent so the audit broken_pointers check passes; decision surface (SCD-protection axis + workups + calculators + panels), test_files, 3-PMID evidence object (high-confidence guideline citations only — no fabricated identifiers), chronic phases all present. Channelopathy drug RxCUIs RxNav-validated 2026-05-16 (quinidine 35220, isoproterenol 6054, acetaminophen 161); ICD/ablation + drug-avoidance non_pharm. 9 trigger/special-pop branches: aborted-SCD secondary prevention, spontaneous-type1+syncope, fever-triggered, ICD-storm quinidine/ablation, drug-avoidance, SCN5A conduction, asymptomatic-intermediate, pregnancy, CKD.

Entry points (5)

  • lab_abnormality
    Type 1 Brugada ECG (coved ST ≥2 mm V1–V2), spontaneous or provoked
    type1_brugada_ecg
  • symptom
    Unexplained syncope (often nocturnal / at rest)
    nocturnal_syncope
  • history
    Aborted SCD / family history of SCD or Brugada
    aborted_scd_or_family
  • history
    Arrhythmia/syncope during febrile illness
    fever_triggered_arrhythmia
  • history
    Known SCN5A / Brugada pathogenic variant
    scn5a_variant

Required inputs (10)

  • agerequired
    demographic • used at CONTEXT
    Risk profile; pediatric fever-triggered events
  • brugada_ecg_patternrequired
    imaging • used at INITIAL_WORKUP
    Spontaneous vs drug-induced type 1 (spontaneous = higher risk)
  • syncope_typerequired
    history • used at RISK_STRATIFICATION
    Arrhythmic (vs vasovagal) syncope is a major ICD risk factor
  • aborted_scdrequired
    history • used at RISK_STRATIFICATION
    Aborted SCD / sustained VT = secondary-prevention ICD (Class I)
  • family_scd
    history • used at CONTEXT
    Family SCD history + cascade screening
  • scn5a_genotype
    history • used at BRANCHING_WORKUP
    SCN5A status — cascade + conduction-disease risk
  • fever_historyrequired
    history • used at CONTEXT
    Fever unmasks/triggers BrS arrhythmia — antipyretic plan
  • current_medsrequired
    medication • used at CONTEXT
    Detect Na-blockers/psychotropics on brugadadrugs.org avoid-list
  • atrial_fibrillation
    history • used at CONTEXT
    AF common in BrS; antiarrhythmic choice constrained (avoid class IC)
  • creatininerequired
    lab • used at TREATMENT
    Quinidine dosing; comorbidity

12-phase flow (12)

  1. 1FRAME
    Confirm BrS suspicion (type 1 ECG / arrhythmic syncope / family SCD); not benign RBBB/early repolarization
    inputs: brugada_ecg_pattern
    advance: BrS clinically suspected
  2. 2ENTRY
    Type 1 ECG, nocturnal syncope, aborted SCD, fever-triggered event, gene-positive
    inputs: age
    advance: entry trigger captured
  3. 3CONTEXT
    Genotype, fever history, drug exposures (brugadadrugs.org), AF, family
    inputs: fever_history, current_meds, family_scd, atrial_fibrillation
    advance: genetic + trigger + drug context complete
  4. 4RED_FLAGS
    Aborted SCD, sustained VT/VF, ICD electrical storm
    inputs: aborted_scd, syncope_type
    actions: cardiogenic_shock
    advance: no red flags or routed to acute/storm pathway
  5. 5INITIAL_WORKUP
    12-lead ECG incl. high right precordial leads; ambulatory monitor
    inputs: brugada_ecg_pattern
    actions: panel.cardiac
    advance: ECG pattern characterised
  6. 6BRANCHING_WORKUP
    Na-channel-blocker provocation (ajmaline/procainamide) if non-diagnostic; genetics; EP programmed stimulation (debated); Shanghai score
    inputs: scn5a_genotype
    actions: preop_cardiac
    advance: diagnosis confirmed + risk inputs gathered
  7. 7DIFFERENTIAL
    BrS vs Brugada phenocopy (ischemia/electrolyte/drug) vs RBBB vs ARVC vs early repolarization
    inputs: brugada_ecg_pattern
    advance: true BrS confirmed
  8. 8RISK_STRATIFICATION
    Sieira/Shanghai: spontaneous type 1 + arrhythmic syncope/aborted SCD = high; asymptomatic spontaneous = intermediate; drug-induced asymptomatic = low
    inputs: brugada_ecg_pattern, syncope_type, aborted_scd
    advance: risk class + ICD decision assigned
  9. 9TREATMENT
    ICD by risk; quinidine for recurrent VF/ICD storm or ICD-declined; epicardial RVOT ablation for refractory storm; aggressive antipyretic fever plan; brugadadrugs.org avoidance; cascade
    inputs: creatinine
    advance: ICD + quinidine + fever/drug-avoidance + cascade plan documented
  10. 10DISPOSITION
    Inherited-arrhythmia centre + EP; genetic counseling
    inputs: scn5a_genotype
    actions: preop_cardiac
    advance: specialist referral + counseling plan set
  11. 11MONITORING
    ICD interrogation; symptom + fever-plan adherence; reassess if new syncope
    actions: panel.cardiac
    advance: monitoring cadence documented
  12. 12FOLLOWUP
    First-degree family cascade screening; lifelong drug-avoidance + fever education
    inputs: scn5a_genotype
    advance: cascade + long-term plan documented