Intensive research is currently underway to better define the risk of sudden death related to the Brugada syndrome. There are several controversial issues regarding the need for and value of electrophysiological study, use of medications vs. ICD and need for noninvasive or invasive screening of family members.

Patients with documented or suspected Brugada syndrome can be classified in several categories:

A. - Individuals with a spontaneously typical electrocardiogram:

1. Symptomatic individual (with syncope or aborted sudden death).
2. Asymptomatic individual.
3. Member of a symptomatic family.
4. Member of an asymptomatic family.

B.- Individuals with an abnormal electrocardiogram unmasked by sodium channel blockers (ajmaline, flecainide, procainamide, pilscainide).

1. Symptomatic individual
2. Asymptomatic individual
3. Member of a symptomatic family
4. Member of an asymptomatic family
5. Brugada syndrome uncovered by antiarrhythmic drugs in an individual treated because of atrial fibrillation.

The following are insights from published literature:

• There is no evidence that prognosis is different between symptomatic individuals with a spontaneously abnormal ECG and those with an abnormal ECG unmasked by drugs.
• Asymptomatic individuals with a basal normal electrocardiogram (positive only after sodium blockers) seem to have a better prognosis.

Controversy is still ongoing regarding the predictive value of electrophysiological study.

• There is no published evidence that an implantable defibrillator is necessary or of any benefit in asymptomatic, non-inducible individuals coming from asymptomatic families.
• Some studies indicate that asymptomatic patients who are inducible should be considered for an implantable defibrillator. Other studies do not support this approach.
• Some investigators suggest that asymptomatic individuals, who are non-inducible, but who come from a family with a history of sudden death related to Brugada syndrome should be offered the option of an implantable defibrillator, recognizing that scientific data in support of a definitive recommendation are not available at this time.