LETTER TO THE EDITOR Family Screening for Brugada Syndrome in Asymptomatic Young Patients. Is it Better not to Know? M. Cecilia Gonzalez Corcia 1,2 • Pedro Brugada 1 Received: 30 March 2017 / Accepted: 9 May 2017 Ó Springer Science+Business Media New York 2017 Brugada syndrome is an inherited disease characterized by coved-type ST-segment elevation in the right precordial leads and increased risk of sudden cardiac death [1]. This pattern is spontaneously, or is unmasked by intravenous administration of a Class I antiarrhythmic drugs [2]. Although Brugada syndrome is very rare in children [3, 4], the disease can manifest at a very young age causing lethal arrhythmias [5, 6]. The main question that arises is: ‘‘Should asymptomatic children from families diagnosed with Brugada syndrome undergo a provocative test?’’ This situation has been addressed in the literature during recent years. The first consideration relates to the risks of provocative tests in children. Several studies concluded that ajmaline testing is safe and feasible in children when performed in an appropriate setting by an experienced team [7, 8]. At present, the main concern lies in the value of a diagnosis in asymptomatic young patients. Arguments against universal familiar screening are based on the fact that an isolate electrocardiographic pattern does not con- stitute a syndrome, and that an electric diagnosis may represent a psychological burden without any compen- satory advantage. Based on years of progressive experience acquired by follow-up of a large familial cohort, our group has recently published data supporting that asymptomatic young patients with Brugada syndrome are at low risk [5]. However, this risk exists, and the turn point from asymp- tomatic to symptomatic can be a sudden death event. We believe that an electrocardiographic diagnosis allows initial risk stratification, and permits both the family and the clinician to set a plan of follow-up over the childhood years. We acknowledge the fact that carrying a potentially life-threatening condition may also result in significant psychological consequences for the child and the family, but at the same time it helps them to face the condition with founded bases, and reduces the psychological impact of ‘‘not knowing.’’ Conversely, a negative pharmacological challenge can provide peace of mind to the family. Overall, it has been our experience that, when given the possibility to choose, most parents opt to know their children’s risks. The indication to perform a provocative test should be individually made considering the genetic information, medical history, psychological aspects, and wishes and preferences of the family. It is our practice to recommend familiar screening for Brugada syndrome, and to provide the family with all the information and support to make the best decision for their children. Compliance with Ethical Standards Conflict of interest The authors declare that they have no conflict of interest. References 1. Brugada P, Brugada J (1992) Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome. A multicenter report. J Am Coll Cardiol 20:1391–1396 2. Priori SG, Wilde AA, Horie M, Cho Y, Behr ER, Berul C, Blom N, Brugada J, Chiang CE, Huikuri H, Kannankeril P, Krahn A, Leenhardt A, Moss A, Schwartz PJ, Shimizu W, Tomaselli G, & M. Cecilia Gonzalez Corcia mariaceciliagonzalezverbist@gmail.com 1 Heart Rhythm Management Centre, UZ Brussels-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium 2 Pediatric Cardiology Department, St Luc Hospital, Brussels, Belgium 123 Pediatr Cardiol DOI 10.1007/s00246-017-1637-2