New Onset Symptoms Following cardiological consultation for Brugada Syndrome

Dear Editor,

The incidental diagnosis of Brugada syndrome (BrS) may profoundly affect patients who had previously considered themselves healthy. Beyond arrhythmic risk stratification, the psychological consequences of communicating such a diagnosis deserve greater attention.

A 67-year-old farmer was referred to a tertiary cardiology center after a type 1 Brugada electrocardiographic pattern was identified. During the consultation, he received a detailed explanation of the currently accepted electrophysiological mechanisms underlying BrS, including alterations in inward sodium and calcium currents, the transmural dispersion of repolarization, and the potential for phase-2 re-entry leading to malignant ventricular arrhythmias. He was reassured that his arrhythmic risk appeared relatively low because he had never experienced syncope or cardiac arrest, although further electrophysiological evaluation was proposed to refine risk stratification.

Despite this reassuring assessment, over the following three months the patient attended my office almost weekly, complaining of dyspnea, diaphoresis, palpitations, dizziness, near-syncope, and persistent diarrhea. He gradually lost interest in his daily activities, frequently stopped working on his farm, woke up late in the morning, and abandoned sexual activity. None of these symptoms had been present before the diagnosis.

Although anecdotal, this case illustrates the substantial psychological burden that may accompany the diagnosis of BrS. Recent studies have confirmed that anxiety, depressive symptoms, and impaired quality of life are relatively common after diagnosis, particularly in susceptible individuals or in those with a previous psychiatric history ^1,2. Approximately 15-16% of patients experience clinically relevant anxiety or depressive symptoms, highlighting the need for systematic psychological assessment during follow-up ^{1, 2}.

Unlike many chronic cardiovascular diseases, BrS has no pharmacological treatment capable of providing patients with a reassuring perception of protection. Consequently, the awareness of carrying a potentially life-threatening condition may itself become a major source of emotional distress. Whether the intense psychological stress induced by an unexpected diagnosis could generate a sustained hyperadrenergic state capable of contributing to arrhythmogenesis remains speculative. Nevertheless, this hypothesis deserves further investigation, given the well-recognized interaction between the autonomic nervous system and ventricular arrhythmias.

Current evidence also suggests that multidisciplinary management involving cardiologists, psychologists, and psychiatrists may mitigate the psychological consequences of BrS, particularly in patients with pre-existing psychiatric disorders or marked emotional vulnerability ^3-4.
Beyond risk stratification and therapeutic decisions, physicians should carefully consider how the diagnosis is communicated. Providing highly detailed electrophysiological explanations during the first consultation may inadvertently increase anxiety in some patients. A more patient-centered communication strategy, combining clear information with empathy and appropriate psychological support, could reduce unnecessary distress while preserving informed decision-making ⁵. Such an approach may ultimately improve not only quality of life but also adherence to follow-up and, potentially, clinical outcomes.