Current Perspective for Atrial Fibrillation in Patients with Brugada Syndrome: A Comprehensive Review

Brugada syndrome (BrS) is an inherited cardiac arrhythmia disorder associated with sudden cardiac death (SCD), primarily due to ventricular tachycardia (VT) or ventricular fibrillation (VF). Meanwhile, atrial fibrillation (AF) is becoming increasingly recognized in BrS cases, with a higher prevalence noted among individuals harboring Sodium Voltage-Gated Channel Alpha Subunit 5 (<i>SCN5A</i>) variants. However, the prognostic value and management implications of AF in BrS remain unclear. Therefore, this narrative review aims to summarize current evidence on the prevalence, clinical significance, pathophysiological mechanisms, and management of AF in BrS. Relevant studies were identified through systematic searches in the PubMed, EBSCOhost, and Google Scholar databases from inception to July 2025 using Boolean operators with keywords such as "Brugada Syndrome" AND "Atrial Fibrillation", "Brugada" AND "AF" AND "Management", and "Brugada" AND "SCN5A" AND "Atrial Arrhythmia". The bibliographies of the selected articles were further reviewed to identify additional relevant studies. The prevalence of AF among patients with BrS ranged from 6% to 39% across various cohorts. Observational studies demonstrated a higher incidence of <i>SCN5A</i>-positive BrS, suggesting that overlapping atrial and ventricular arrhythmogenic substrates exist. Unrecognized BrS in patients presenting with AF may result in inappropriate administration of sodium channel-blocking agents, potentially triggering malignant ventricular arrhythmias. Management strategies include the careful selection of antiarrhythmic drugs, consideration of pulmonary vein isolation (PVI), and implantation of an implantable cardioverter-defibrillator (ICD) device in high-risk cases. Quinidine remains a potential pharmacological option for recurrent ventricular arrhythmias. AF is a relatively common but understudied arrhythmia in BrS. While the direct association of AF with SCD remains uncertain, AF may serve as a marker of a more arrhythmogenic phenotype in BrS. Nonetheless, current guidelines provide limited recommendations for managing AF in this population, underscoring the need for individualized treatment strategies and further research.