Short answer: yes. Brugada Patients are at risk of ventricular fibrillation. They don´t need stimulation. Detection of VF and defibrillation is safe with the S-ICD. Therefore, especially for young patients, for whom we fear lead complications, the S-ICD is the best option.

But have a carefull look at sensing with S-ICD after implantation and perform a treadmill-test to avoid T-Wave Oversensing. That is a problem in hypertrophic cardiomyopathy and Brugada.

If there is an indication for a subcutaneous ICD, it is Brugada syndrome, because in all other indication intracardia pacing is mandatory to terminate VTs and avoid shocks. Only sensing may be a problem as Florian Reinke mentioned above. In addition, Brugada patients have a high risk of AF with fast conduction, which may cause detection problems without intracardiac electrograms.

Not yet. May be with future S-ICD generations. We don't yet known long-term sc leads complications and the device is still too big and without remote minitoring. Another problem is of course T-Wave Oversensing.

Let's wait next generation devices and long-term studies.

I wonder if we want to treat an ECG (1 type 1 ecg per 1000 inhabitants) or a syndrome that is a so so rare event still porly understood.

In the first case we do not need any device, but only to ameliorate our knowlegde on risk stratification.

In the second case (if a real syndrome is presente), Classic ICD implantation is the rule.

I assume the patient has an indication for an ICD according to the guidelines. In this case I would rather use a conventional system. Your young patient will need the system for an indefinite timeframe, and in a young patient transvenous systems are easy implantable, can be placed nearly invisible (which is an important factor for young people) and it has a proven long longevity (simple VVI ICD transvenous system) with a low complication rate. Other potential arguments against subcutaneous systems are: Sport participation, T wave oversensing,

I see the use of a subcutaneous system rather in a patient with access problems (congenital heart disease, thrombotic problems or a system which is there for a limited time only (e.g. pre-transplant).