The Management of Vasovagal Syncope in a Patient with Brugada Syndrome

A higher susceptibility to vasovagal syncope has been reported in patients with Brugada syndrome (BrS) and may be caused by associated autonomic dysfunction. In general, syncope is an adverse prognostic sign in patients with BrS but it is unclear what risk vasovagal syncope confers to patients with BrS. Trigger avoidance, protective measures, increased fluid and salt intake, and avoidance of alcohol, caffeine, and diuretics are important first steps. If patients have recurrent episodes despite these initial measures, physical counterpressure maneuvers and pharmacologic therapy with midodrine are the next steps. If a patient with BrS presents with vasovagal syncope, they should not undergo cardioverterdefibrillator implantation. Additional risk stratification should be performed before considering implantable cardioverter-defibrillator therapy.