Sir,—I read with interest the case report from Japan of a patient with Brugada syndrome associated with an autonomic disorder.1 The patient lost consciousness on two occasions, and ventricular fibrillation was documented in the cardiac catheterisation laboratory. But no mention was made of treatment, which should include implantation of an automatic cardioverter defibrillator.

The Brugada syndrome occurs not only in caucasian2 ,3 but also in oriental people, including Japanese1 ,4 and Chinese people.5 It has recently been speculated that the sudden unexplained death syndrome (SUDS) in young Thai men and other Southeast Asians may have features similar to Brugada syndrome, including an intermittent right bundle branch block on ECG with pronounced ST elevation.6 However, patients with SUDS die at night while asleep6 ,7; in contrast patients with Brugada syndrome do not have symptoms during sleep.5

The diagnosis of Brugada syndrome calls for implantation of an implantable cardioverter defibrllator8 because of the high risk of sudden death, especially in young patients.4 Even in initially asymptomatic patients, the incidence of ventricular fibrillation occurring later is high.5 Therefore, all patients with Brugada syndrome should have an implantable cardioverter defibrillator as a definitive treatment.2 ,3 ,5 ,8