{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:50:54Z","timestamp":1753876254160,"version":"3.41.2"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2024,4,22]],"date-time":"2024-04-22T00:00:00Z","timestamp":1713744000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The Brugada syndrome (BrS) is an inherited disorder associated with the risk of ventricular fibrillation and sudden cardiac death (SCD). The current main therapy is an implantable cardioverter-defibrillator (ICD). However, the risk stratification and management of patients remain challenging. Here, we present a case of BrS representative of the pitfalls that clinicians may encounter in the management of Brugada patients in routine clinical practice.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A 39-year-old man with BrS and recurring syncope was implanted with a subcutaneous ICD (S-ICD) (EMBLEM MRI S-ICD, Boston Scientific). Syncope recurred some months later. Subcutaneous ICD interrogation showed no arrhythmic events, but SMART Pass (high-pass filter) deactivation was noted. A query was sent to Boston Scientific clinical service, unveiling an extremely long asystolic pause as syncope determinant. Subcutaneous ICD was explanted and replaced by conventional single chamber ICD in the pre-pectoral region.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Brugada syndrome patients with high-risk features are candidates for ICD implantation to prevent SCD. Recent evidence highlighted that symptomatic patients carry a substantially higher risk compared with asymptomatic ones. Syncope may represent a pivotal symptom in BrS patients, but young patients with Type 1 Brugada pattern may experience syncope other than from tachyarrhythmias. Subcutaneous ICD is an advisable option in young ICD recipients to avoid lifetime complication related to standard transvenous systems. However, S-ICD lacks pacing capabilities and, therefore, is not indicated when an anti-bradycardia system is needed. The diagnostic workup of syncope in Brugada patients may be ineffective in elucidating the underlying aetiology whose understanding is essential to offer a personalized therapeutic approach.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytae201","type":"journal-article","created":{"date-parts":[[2024,4,22]],"date-time":"2024-04-22T19:21:35Z","timestamp":1713813695000},"source":"Crossref","is-referenced-by-count":2,"title":["Unconventional diagnosis of bradyarrhythmic syncope in Brugada syndrome: a case report"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4014-547X","authenticated-orcid":false,"given":"Francesca","family":"Esposito","sequence":"first","affiliation":[{"name":"Department of Cardiology, AORN \u2018San Giuseppe Moscati\u2019 , Contrada Amoretta, Avellino 83100 , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6548-0354","authenticated-orcid":false,"given":"Felice","family":"Nappi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, AORN \u2018San Giuseppe Moscati\u2019 , Contrada Amoretta, Avellino 83100 , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6805-8707","authenticated-orcid":false,"given":"Francesco","family":"Urraro","sequence":"additional","affiliation":[{"name":"Department of Cardiology, AORN \u2018San Giuseppe Moscati\u2019 , Contrada Amoretta, Avellino 83100 , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7844-7407","authenticated-orcid":false,"given":"Paolo","family":"Vitillo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, AORN \u2018San Giuseppe Moscati\u2019 , Contrada Amoretta, Avellino 83100 , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Rotondi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, AORN \u2018San Giuseppe Moscati\u2019 , Contrada Amoretta, Avellino 83100 , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,4,22]]},"reference":[{"key":"2024050611425859200_ytae201-B1","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1161\/01.CIR.97.5.457","article-title":"Right bundle-branch block and ST segment elevation in leads V1 through V3: a marker for sudden death in patients without demonstrable structural heart disease","volume":"97","author":"Brugada","year":"1998","journal-title":"Circulation"},{"key":"2024050611425859200_ytae201-B2","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1016\/j.hrthm.2014.04.010","article-title":"A comprehensive electrocardiographic, molecular, and echocardiographic study of Brugada syndrome: validation of the 2013 diagnostic criteria","volume":"11","author":"Savastano","year":"2014","journal-title":"Heart Rhythm"},{"key":"2024050611425859200_ytae201-B3","doi-asserted-by":"crossref","first-page":"2566","DOI":"10.1161\/CIRCULATIONAHA.111.082313","article-title":"Pacemaker therapy in patients with neurally mediated syncope and documented asystole","volume":"125","author":"Brignole","year":"2012","journal-title":"Circulation"},{"key":"2024050611425859200_ytae201-B4","doi-asserted-by":"crossref","first-page":"3997","DOI":"10.1093\/eurheartj\/ehac262","article-title":"2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death","volume":"43","author":"Zeppenfeld","year":"2022","journal-title":"Eur Heart J"},{"key":"2024050611425859200_ytae201-B5","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1016\/j.hrthm.2018.05.011","article-title":"Prospective blinded evaluation of a novel sensing 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