Editing Brugada syndrome (section)

== Treatment ==
[[File:AICD.jpg|thumb|upright=1.3|Illustration of an implanted cardioverter-defibrillator]]

The main aim when treating people with Brugada syndrome is to reduce the risk of sudden death due to serious [[Heart arrhythmia|abnormal heart rhythms]] such as ventricular fibrillation or polymorphic ventricular tachycardia.<ref>{{cite journal | vauthors = Gourraud JB, Barc J, Thollet A, Le Scouarnec S, Le Marec H, Schott JJ, Redon R, Probst V | title = The Brugada Syndrome: A Rare Arrhythmia Disorder with Complex Inheritance | journal = Frontiers in Cardiovascular Medicine | volume = 3 | pages = 9 | date = 2016 | pmid = 27200363 | pmc = 4842929 | doi = 10.3389/fcvm.2016.00009 | doi-access = free }}</ref> While some with this condition are at high risk of serious heart rhythm disturbances, others are at much lower risk, meaning that some may require more intensive treatment than others.<ref name = Pri2013 />  In addition to treating the person who has Brugada syndrome, it is often important to investigate members of their immediate family to see if they too carry the condition.<ref name="Pri2013" />

=== Lifestyle ===
The first line of treatment, suitable for all people with Brugada syndrome regardless of their risk of arrhythmias, is lifestyle advice.<ref name=Pri2013 /> People should be advised to recognise and avoid things that may increase the risk of serious arrhythmias.  These include avoiding excessive alcohol consumption, avoiding certain medications,<ref name="Postema_2009">{{cite journal | vauthors = Postema PG, Wolpert C, Amin AS, Probst V, Borggrefe M, Roden DM, Priori SG, Tan HL, Hiraoka M, Brugada J, Wilde AA | title = Drugs and Brugada syndrome patients: review of the literature, recommendations, and an up-to-date website (www.brugadadrugs.org) | journal = Heart Rhythm | volume = 6 | issue = 9 | pages = 1335–41 | date = September 2009 | pmid = 19716089 | pmc = 2779019 | doi = 10.1016/j.hrthm.2009.07.002 }}</ref> and treating fever promptly with [[paracetamol]].<ref name=Pri2013 /> Although the abnormal heart rhythms seen in Brugada syndrome are generally more likely to occur at rest or even during sleep, some people with Brugada syndrome experience arrhythmias during strenuous exercise.  Some physicians may therefore advise people with Brugada syndrome that while gentle exercise is helpful, very strenuous exercise should be avoided.<ref name="Mascia_2017">{{cite journal | vauthors = Mascia G, Arbelo E, Ojeda JH, Solimene F, Brugada R, Brugada J | title = Brugada Syndrome and Exercise Practice: Current Knowledge, Shortcomings and Open Questions | journal = International Journal of Sports Medicine | volume = 38 | issue = 8 | pages = 573–581 | date = July 2017 | pmid = 28625016 | doi = 10.1055/s-0043-107240 | s2cid = 3868956 | url = https://www.openaccessrepository.it/record/203070 }}</ref><ref name="Masrur_2015">{{cite journal | vauthors = Masrur S, Memon S, Thompson PD | title = Brugada syndrome, exercise, and exercise testing | journal = Clinical Cardiology | volume = 38 | issue = 5 | pages = 323–6 | date = May 2015 | pmid = 25955277 | doi = 10.1002/clc.22386 | pmc = 6711014 }}</ref>

=== Implantable defibrillator ===
In people felt to be at higher risk of sudden cardiac death, an [[implantable cardioverter-defibrillator]] (ICD) may be recommended.<ref name=Pri2013 />  These small devices implanted under the skin continuously monitor the heart rhythm.  If the device detects a potentially life-threatening arrhythmia it can give the heart a small electric shock, stunning the heart back into a normal rhythm.<ref name="Rickard_2016">{{cite journal | vauthors = Rickard J, Wilkoff BL | title = Advances in implantable cardioverter defibrillator therapy | journal = [[Expert Review of Cardiovascular Therapy]] | volume = 14 | issue = 3 | pages = 291–9 | date = 2016 | pmid = 26653411 | doi = 10.1586/14779072.2016.1131124 | s2cid = 6423194 }}</ref> An ICD can also function as a [[Artificial cardiac pacemaker|pacemaker]], preventing abnormally slow heart rates that can also occur in people with Brugada syndrome.

Implanting an ICD is a relatively low-risk procedure and is frequently performed as a day case under [[Local anesthetic|local anaesthetic]].<ref name="Rickard_2016" /> However, complications such as infection, bleeding or unnecessary shocks can occur, which can sometimes be serious.<ref>{{cite journal | vauthors = Olde Nordkamp LR, Postema PG, Knops RE, van Dijk N, Limpens J, Wilde AA, de Groot JR | title = Implantable cardioverter-defibrillator harm in young patients with inherited arrhythmia syndromes: A systematic review and meta-analysis of inappropriate shocks and complications | journal = Heart Rhythm | volume = 13 | issue = 2 | pages = 443–54 | date = February 2016 | pmid = 26385533 | doi = 10.1016/j.hrthm.2015.09.010 }}</ref> Because of the small risk associated with implanting an ICD, as well as the cost of the devices, ICDs are not recommended for all people with Brugada syndrome but are instead reserved for people deemed at higher risk of sudden cardiac death.<ref name=Pri2013 />

=== Medication ===
[[Quinidine]] is an antiarrhythmic drug that may reduce the chance of serious abnormal heart rhythms occurring in some people with Brugada syndrome.<ref name=Bel2004/><ref>{{cite journal | vauthors = Yang F, Hanon S, Lam P, Schweitzer P | title = Quinidine revisited | journal = The American Journal of Medicine | volume = 122 | issue = 4 | pages = 317–21 | date = April 2009 | pmid = 19249010 | doi = 10.1016/j.amjmed.2008.11.019 }}</ref> It is most frequently used in people with Brugada syndrome who have an ICD and have experienced several episodes of life-threatening arrhythmias, but may also be used in people at high risk of arrhythmias but in whom an ICD is not appropriate.<ref name=Pri2013 />

[[Isoprenaline]], a drug that has similarities with [[adrenaline]], can be used in an emergency for people with Brugada syndrome who are having frequent repeated life-threatening arrhythmias, known as an "electrical storm".<ref name=Pri2013 /> This drug must be given as a continuous infusion into a vein and therefore is not suitable for long-term use.

=== Catheter ablation ===
A further treatment option for people with Brugada syndrome is [[Catheter ablation|radiofrequency catheter ablation]].<ref>{{cite journal | vauthors = Kautzner J, Peichl P | title = Catheter ablation to prevent sudden cardiac death | journal = International Journal of Cardiology | volume = 237 | pages = 29–33 | date = June 2017 | pmid = 28433554 | doi = 10.1016/j.ijcard.2017.03.135 }}</ref> In this procedure, wires are passed through a vein in the leg into the heart, or through a small hole underneath the [[sternum]].  These wires are used to find the area of the heart responsible for initiating the arrhythmias.  The tip of one of these wires is used to make a series of tiny burns, intentionally damaging the area of abnormal heart muscle that has been causing the problem.  Current recommendations suggest that this treatment should be reserved for those with Brugada syndrome who have had repeated shocks from an ICD.<ref name=Pri2013 />