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Circulation. 2018;138:e272–e391. DOI: 10.1161/CIR.0000000000000549 September 25, 2018 e331 CLINICAL STATEMENTS AND GUIDELINES

atic review conducted by the ERC are denoted by the superscript SR (eg, LOE: B-RSR). Factors identified as potential triggers of VF and SCA in Brugada syndrome include some psychotropic medications, and anesthetic agents, cocaine, excessive alcohol intake, and fever (www.brugadadrugs.org).S7.9.1.3-21,S7.9.1.3-22 These agents should be avoided, and fever warrants early and aggressive measures to reduce temperature.S7.9.1.3-23

Recommendation-Specific Supportive Text

1.	 The risk of major adverse cardiac events in asymptomatic patients without spontaneous type 1 electrocardiographic changes of Brugada syndrome (Figure  15), or with only medication-induced electrocardiographic changes, is low.S7.9.1.3-1–S7.9.1.3-5 A positive family history of Brugada syndrome or SCA is not a significant predictor of adverse events in Brugada syndrome.S7.9.1.3-1,S7.9.1.3-2,S7.9.1.3-4,S7.9.1.3-5 Implantation of an ICD in an asymptomatic patient without a spontaneous type 1 Brugada electrocardiographic has not been shown to confer any benefit. 2.	 Brugada syndrome is characterized by coved ST elevation in leads V1 or V2 positioned in the second, third, or fourth intercostal space either spontaneously or induced by administration of a sodium channel–blocking drug in the absence

Figure 14. Prevention of SCD in patients with Brugada syndrome. Colors correspond to Class of Recommendation in Table 1. See Section 7.9.1.3 for discussion. *ICD candidacy as determined by functional status, life expectancy or patient preference. 1° indicates primary; ECG, electrocardiogram; EP, electrophysiological; ICD implantable cardioverter-defibrillator; SCD, sudden cardiac death; VT, ventricular tachycardia; and VF, ventricular fibrillation.

Figure 15. Brugada syndrome.

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