Introduction: Brugada syndrome (BrS) has low prevalence (14-30:10000), it is more common in men and people from Asia, and it is characterized by typical ECG changes as well as high incidence of sudden cardiac death (SCD). ICD implantation is the only SCD prevention option. HRS/EHRA/APHRS Consensus article (1) states the indications for ICD implantation, but asymptomatic patients, or those with syncope of unclear origin can be hard for risk stratification. (2, 3)

Case reports: We are presenting two cases from our hospital. A 40-year-old male was seen for atrial fibrillation and type II ECG changes. There were no SCD in family, and he never had syncope. Pulmonary vein isolation (PVI) was done, then ajmaline test (positive) and finally electrophysiology study (EPS) (negative). A 36-year-old male with type II ECG was admitted after syncope which occurred during rest on a hot day at a picnic. Holter as well as neurologic workup were normal. Ajmaline test was positive and EPS negative. Both patients were instructed to avoid specific drugs, to change lifestyle and prevent high fever with antipyretics. Guidelines clearly state ICD should be implanted to SCD survivors or sustained ventricular tachycardia (VT), it can be useful in patients with type I ECG changes and a syncope, and it may be considered in EPS inducible patients. First patient is in follow up because he doesn’t fulfill any criteria. Also he was previously treated with propafenone without any problems, which is also a possible sign of lower risk for SCD, finally he was successfully treated for atrial fibrillation, which is linked ventricular arrhythmias in BrS patients, so this was also a tool to lower his risk. Second patients had a syncope, but other syncope etiologies are possible, he has type II ECG changes and arrhythmia is not inducible therefore he is also in follow up.

Conclusion: Potentially lethal arrhythmias in asymptomatic patients develop in 1-8% in 3 years (Brugada; Eckardt; Probst). Finally, EPS reccommendations are not clearely defined, therefore we are still conducting EPS as an adjuvant tool for risk stratification.