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The association of Brugada syndrome (BrS) and atrial fibrillation (AF) is well known, but its prognostic significance has not been well defined. In 1992, the Brugada brothers described 8 patients with a syndrome of ST segment elevation in ECG leads V1–V3 associated with right bundle branch block appearance and the risk of ventricular fibrillation (VF) and sudden cardiac death. One patient was an 8-year-old girl with an additional history of paroxysmal AF. She experienced her first paroxysm of AF soon after birth, while her first episode of syncope occurred at 8 years of age. Patients with a spontaneous type 1 ECG pattern, those with inducibility of ventricular arrhythmias, or those who fulfilled criteria for an implantable cardioverter have a higher incidence of atrial arrhythmias, suggesting that atrial arrhythmias may be considered as an indicator for more severe disease. The recent HRS/EHRA expert consensus statement does not recommend genetic testing for AF because of the limited outcome data available. The most important reason was that none of the current known disease-associated genes for AF has been shown to account for 45% of the disease. However, the possibility that within the large pool of young patients with new-onset AF, a relatively large minority with latent BrS may be at risk of sudden death (as first reported by our group) could potentially increase the diagnostic and prognostic contribution of genetic testing. Recent observations from the Brugada group have supported the results of our seminal work, posing a new challenge for all cardiologists in the management of patients with AF. In our initial experience, this association was analyzed in as many as 346 individuals with new-onset AF

Ventricular fibrillation in lone atrial fibrillation as clinical manifestation of latent Brugada syndrome: Usefulness of flecainide testing