Can an implantable loop recorder improve risk stratification and appropriate management in Brugada syndrome?

Proposed indications to implantable loop reconder (ILR), electrophysiological study (EPS) and therapeutic management in Brugada patients ICD if refused 1Abortedsudden arrhythmic death syncope or ICDor shock Epicardial hydroquinidine ablation OR if refused EPS + or shock Epicardial hydroquinidine ablation + ILR OR 2 Unexplained syncope EPS - ILR Symptomatic for ICD 3 palpitations neurally-mediated or ILR syncope Spontaneous type 1 ECG 4Asymptomaticwith type spontaneous 1 ECG EPS + Epicardial hydroquinidine ablation + ILR OR Based on the study Bergonti et al.12 and other recent publications7,14,15 the flow chart summarizes a possible role for an ILR and EPS in the risk stratification of Brugada patients and a proposal for different therapeutic management, which also considers possible alternatives to ICD implantation. EPS+, induction of sustained ventricular tacchycardia or ventricular fibrillation at electrophysiological study; EPS–, electrophysiological study without arrhythmia inducti...