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Introduction Brugada syndrome (BrS) is a male-predominant cardiac channelopathy associated with increased risk of malignant ventricular arrhythmias and sudden cardiac death (SCD), with global prevalence of ~0.05%. Diagnosis requires a spontaneous or drug-induced type 1 Brugada ECG pattern without alternative structural or metabolic causes. Our study aimed to evaluate baseline characteristics of BrS patients, compare clinical outcomes between spontaneous and drug-induced cohorts, and identify factors associated with each group over a 10-year experience from a large UK tertiary centre.Methods Retrospective cohort study of all consecutive patients diagnosed with BrS at University Hospitals Coventry and Warwickshire NHS Trust between 1 January 2011 and 31 December 2025. Baseline characteristics and outcomes were analysed for spontaneous versus drug-induced type 1 ECG groups. Categorical variables were presented as frequencies and percentages, continuous variables as mean (±SD) or median (+IQR). Nonparametric tests were used for between-group comparisons.Results Thirty-three patients were included, with mean age at diagnosis of 46.1 ± 17.4 years; 54.5% were male (see figure 1). The relevant baseline characteristics are shown in table 1. Most patients were asymptomatic at presentation (n=20). Presenting clinical features by BrS subtype are shown in figure 2A. Sixteen patients had spontaneous type 1 ECGs and 17 had drug-induced BrS ECG-pattern. SCN5A variants were identified in four patients. Initial management included implantable loop recorder (ILR) implantation (n=14), which was more frequent in drug-induced than spontaneous type 1 BrS (71.4% vs 28.6%, p=0.049). The median ILR monitoring duration was 4.0 (3.0–7.0) years, during which no arrhythmias were detected. Additional management included programmed electrical stimulation (n=5, positive n=1), ICD implantation (n=3; primary prevention n=2), and pacemaker implantation (n=1).During a median follow-up of 37.9 months (IQR 5.4–79.3), new symptoms occurred in six patients (see figure 2B). Cardiac-related hospitalisations occurred in two patients: one following an appropriate ICD shock resulting in combined epicardial and endocardial VT ablation, and one for CTI-dependant atrial flutter ablation. Comparison of clinical outcomes by BrS type is shown in table 2. No baseline or clinical factors were more commonly associated with either group. There were no deaths at follow-up.Conclusions Most BrS patients were asymptomatic with favourable medium-term outcomes. Arrhythmic syncope remains a key determinant for primary prevention ICD implantation in combination with spontaneous type 1 ECG, while the ILR appears particularly useful in drug-induced BrS for long-term monitoring. These findings highlight the need for more clearly defined, risk-adapted management pathways for BrS.Abstract 459 Table 1Baseline characteristics of the BrS populationDemographics & Baseline Investigationsn=33Co-morbidities & Risk Factorsn=33Age at diagnosis in years - mean (SD)46.1 (17.4)Smoker - n (%)5 (15.2)Male - n (%)18 (54.5)Alcohol use - n (%)6 (18.2)Caucasian - n (%)24 (72.7)Recreational drug use - n (%)1 (3.0)TTE performed - n (%)21 (63.6)Hypertension - n (%)3 (9.1)Abnormal TTE - n1Diabetes mellitus/Dyslipidaemia - n (%)2 (6.1)CMRI performed - n (%)3 (9.1)Known atrial fibrillation/flutter - n (%)1 (3.0)Abnormal CMRI - n1Cardiomyopathy/heart failure - n (%)0 (0.0)Holter performed - n (%)13 (39.4)Family history of SCD - n (%)5 (15.2)Abnormal Holter - n 1Family history of BrS - n (%)2 (6.1)BrS: Brugada syndrome, CMRI: cardiac magnetic resonance imaging, SCD: sudden cardiac death, TTE: transthoracic echocardiogramAbstract 459 Figure 1Flowchart showing the diagnosis, management and outcome of patients with Brugada syndromeAbstract 459 Table 2Clinical outcomes by BrS type (n=33)Clinical OutcomesBrS typeP-valueSpontaneous n (%)Drug-induced n (%)ILR implantation4 (28.6)10 (71.4)0.049ICD implantation2 (66.7)1 (33.3)0.509PPM implantation0 (0.0)1 (100.0)0.320New symptom(s) during follow-up4 (66.7)2 (33.3)0.320Cardiac-related hospitalisation0 (0.0)2 (100.0)0.157Appropriate ICD shock due to VT/VF0 (0.0)1 (100.0)0.083Atrial/VT ablation0 (0.0)1 (100.0)0.320BrS: Brugada syndrome, ICD: implantable cardioverter defibrillator, ILR: implantable loop recorder, PPM: permanent pacemaker, VF: ventricular fibrillation, VT: ventricular tachycardiaAbstract 459 Figure 2