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Any Brugada syndrome in which the cause of the disease is a mutation in the HCN4 gene.
Features include always present findings: ST segment elevation, Complete right bundle branch block, and Ventricular tachycardia.
Organ System | Phenotype Count | Example Features |
|---|---|---|
Heart and blood vessels | 2 | Complete right bundle branch block, Ventricular tachycardia |
HCN4 encodes hyperpolarization activated cyclic nucleotide gated potassium channel 4 (1,203 aa). Hyperpolarization-activated ion channel that are permeable to Na(+) and K(+) ions with very slow activation and inactivation. Exhibits higher selectivity for K(+) over Na(+) ions. Highest expression in Testis (19.6 TPM) and Heart Atrial Appendage (8.0 TPM).
Brugada syndrome 8 is associated with mutations in the HCN4 gene on chromosome 15.
The HCN4 protein participates in HCN channel Homomer of subunit HCN4 and HCNs:cAMP bind SNIs pathways.
HCN4 is classified as a druggable target (Druggable Genome, Ion Channel, and Transporter categories) with score 17.4.
Brugada syndrome is a channelopathy, caused by genetic changes in transmembrane ion channels that create action potentials, in this case leading to an increased risk of cardiac arrhythmia .
Brugada syndrome should be suspected in individuals with any of the following findings:
Recurrent syncope
Ventricular fibrillation
No approved treatments are currently available for Brugada syndrome 8. The disease remains an area of unmet medical need.
To establish the extent of disease and needs in an individual diagnosed with Brugada syndrome, the following evaluations (if not performed as part of the evaluation that led to the diagnosis) are recommended:
Electrocardiogram (EKG)
At-risk individuals with a family history of Brugada syndrome or a known pathogenic variant should undergo EKG monitoring every one to two years beginning at birth . The presence of type 1 EKG changes should be further investigated.
Source: GeneReviews — "Brugada Syndrome"
Phenotype severity distribution: 3 always present features.
No clinical trials have been registered for Brugada syndrome 8.
88 publications have been identified in PubMed for Brugada syndrome 8. Research spans Epidemiology / Natural History (26%), Case Report / Case Series (24%), and Review / Meta-Analysis (19%).
Research Type | Count | % of Total |
|---|---|---|
Disease patterns and progression | 23 | 26% |
Data assembled from 6 of 12 sources · Last updated Sep 18, 2026, 4:03 AM UTC
Online Mendelian Inheritance in Man
Genetic and Rare Diseases Info Center
Common questions about Brugada syndrome 8
Age at diagnosis. Brugada syndrome manifests primarily during adulthood, with a mean age of sudden death of approximately 40 years. The youngest individual was diagnosed at two days of life and the oldest was diagnosed at age 85 years . Sex differences. Although Brugada syndrome is more prevalent among males, it affects females as well, and both sexes are at a high risk for ventricular arrhythmias and sudden death . Presentation. Currently, the most common presentation is that of a person in the fifth decade with malignant arrhythmias and a previous history of syncopal episodes. Syncope is a common presenting symptom .
Source: GeneReviews — "Brugada Syndrome"
Few studies have investigated genotype-phenotype correlations .
SCN5A
In general, the SCN5A pathogenic variants which cause LQT3 (see Long QT Syndrome) are associated with a gain of function rather than the loss of function associated with Brugada syndrome and progressive conduction system disease; however, pathogenic variants that are associated with both diseases in the same family have been described.
By restoring (at least partially) sodium current defects, the common SCN5A variant appears to modulate the phenotypic effects of heterozygous SCN5A pathogenic variants such as , which results in clinically significant cardiac conduction disturbances , and , which results in Brugada syndrome .
Source: GeneReviews — "Brugada Syndrome"
SCN5A. Among individuals with an SCN5A pathogenic variant approximately 20%-30% have an EKG diagnostic of Brugada syndrome; and approximately 80% manifest the characteristic EKG changes when challenged with a sodium channel blocker (e.g., ajmaline) .
Source: GeneReviews — "Brugada Syndrome"
Self-terminating polymorphic ventricular tachycardia
Cardiac arrest
Family history of sudden cardiac death
AND one of the following EKG patterns:
Type 1 EKG (elevation of the J wave ≥2 mm with a negative T wave and ST segment that is coved type and gradually descending) in more than one right precordial lead (V1-V3)* with or without administration of a sodium channel blocker (e.g., flecainide, pilsicainide, ajmaline, or procainamide)
Source: GeneReviews — "Brugada Syndrome"
Brugada syndrome should always be considered in the differential diagnosis of the following:
Sudden cardiac death and syncope in persons with a structurally normal heart
SIDS. Brugada syndrome does not usually cause problems at such a young age; however, SCN5A pathogenic variants have been described in a few infants with SIDS. SIDS is believed to be etiologically and genetically heterogeneous with an unknown proportion attributed to Brugada syndrome.
Sick sinus syndrome. Brugada syndrome could be observed in persons with sick sinus syndrome given the defects observed in cardiac conduction .
Other conditions that can be associated with ST segment elevation in right precordial leads include the following (adapted from and with permission).
Source: GeneReviews — "Brugada Syndrome"
Genetic testing for HCN4 is available. Testing is considered confirmatory for diagnosis.
Biomarker and diagnostic research for Brugada syndrome 8 has been reported in the published literature.
Induction with sodium blockers (ajmaline, procainamide, pilsicainide, flecainide) in persons with a type 2 EKG or type 3 EKG and suspicion of the disease
Electrophysiologic study to assess risk of sudden cardiac death. Although the data are controversial, no other risk stratification parameter is presently available for asymptomatic individuals .
Consultation with a medical geneticist, certified genetic counselor, or certified advanced genetic nurse to inform affected individuals and their families about the nature, mode of inheritance, and implications of Brugada syndrome to facilitate medical and personal decision making
Brugada syndrome is characterized by the presence of ST segment elevation in leads V1-V3. Implantable cardioverter defibrillators (ICDs) are the only therapy currently known to be effective in persons with Brugada syndrome with syncope or cardiac arrest . See for risk stratification and recommendations of ICD in individuals with Brugada syndrome. Electrical storms respond well to infusion of isoproterenol (1-3 g/min), the first line of therapy before other antiarrhythmics . It is important to:
Source: GeneReviews — "Brugada Syndrome"
The following can unmask the Brugada syndrome EKG :
Febrile state
Vagotonic agents
Alpha-adrenergic agonists
Beta-adrenergic antagonists
Tricyclic antidepressants
First-generation antihistamines (dimenhydrinate)
Cocaine toxicity
The following should be avoided :
Class 1C antiarrhythmic drugs including flecainide and propafenone
Class 1A agents including procainamide and disopyramide
Source: GeneReviews — "Brugada Syndrome"
Search ClinicalTrials.gov in the US and EU Clinical Trials Register in Europe for access to information on clinical studies for a wide range of diseases and conditions. Note: There may not be clinical trials for this disorder.
Source: GeneReviews — "Brugada Syndrome"
View trials for Brugada syndrome 8
21 |
24% |
Research summaries | 17 | 19% |
Testing and diagnosis research | 8 | 9% |
Laboratory research | 8 | 9% |
Clinical study results | 7 | 8% |
Other research | 2 | 2% |
New treatment approaches | 2 | 2% |
Sano N (2026). [PMID: 41772817](https://pubmed.ncbi.nlm.nih.gov/41772817/). *J Cardiovasc Electrophysiol*. [Diagnostic / Biomarker]
Cholasseri R (2026). [PMID: 41664850](https://pubmed.ncbi.nlm.nih.gov/41664850/). *Phys Chem Chem Phys*. [Review / Meta-Analysis]
Ali AR (2026). [PMID: 41524999](https://pubmed.ncbi.nlm.nih.gov/41524999/). *Egypt Heart J*. [Epidemiology / Natural History]
Bhardwaj P (2026). [PMID: 41999290](https://pubmed.ncbi.nlm.nih.gov/41999290/). *Eur Heart J Qual Care Clin Outcomes*. [Epidemiology / Natural History]
Clark CJ (2026). [PMID: 41878815](https://pubmed.ncbi.nlm.nih.gov/41878815/). *Circ Res*. [Basic Science / Preclinical]
Takada Y (2026). [PMID: 41704830](https://pubmed.ncbi.nlm.nih.gov/41704830/). *Eur Heart J Case Rep*. [Case Report / Case Series]
Barbosa LM (2026). [PMID: 41243368](https://pubmed.ncbi.nlm.nih.gov/41243368/). *J Cardiovasc Electrophysiol*. [Review / Meta-Analysis]
Robinson KM (2026). [PMID: 41802778](https://pubmed.ncbi.nlm.nih.gov/41802778/). *BMJ Paediatr Open*. [Case Report / Case Series]
Martínez-Barrios E (2026). [PMID: 41596527](https://pubmed.ncbi.nlm.nih.gov/41596527/). *Int J Mol Sci*. [Basic Science / Preclinical]
Bhatia K (2026). [PMID: 42134031](https://pubmed.ncbi.nlm.nih.gov/42134031/). *Int J Obstet Anesth*. [Epidemiology / Natural History]