Skip to main content

Drug Challenge in Brugada Syndrome: How Valuable Is It?

  • Chapter
Cardiac Arrhythmias 2005
  • 661 Accesses

Conclusions

In patients with structurally normal hearts and unexplained syncope or cardiac arrest, Brugada syndrome is considered a frequent underlying condition. In patients with suspected Brugada syndrome but inconclusive or normal ECG findings at baseline, drug challenge with intravenous administration of sodium channel blockers according to a standardised protocol is a powerful tool to unmask diagnostic type-1 Brugada ECG features and thereby identify patients at risk of sudden death. The additional impact of drug challenge in the risk stratification algorithms of patients already diagnosed with Brugada syndrome is less well-established and requires additional studies.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

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

    Article  PubMed  CAS  Google Scholar 

  2. Miyasaka Y, Tsuji H, Yamada K et al (2001) Prevalence and mortality of the Brugada-type electrocardiogram in one city in Japan. J Am Coll Cardiol 38:771–774

    Article  PubMed  CAS  Google Scholar 

  3. Antzelevitch C, Brugada P, Borggrefe M et al (2005) Brugada syndrome: Report of the second consensus conference. Circulation 111:659–670

    Article  PubMed  Google Scholar 

  4. Antzelevitch C (2001) The Brugada syndrome: ionic basis and arrhythmia mechanisms. J Cardiovasc Electrophysiol 12:268–272

    Article  PubMed  CAS  Google Scholar 

  5. Brugada R, Brugada J, Antzelevitch C et al (2000) Sodium channel blockers identify risk for sudden death in patients with ST-segment elevation and right bundle branch block but structurally normal hearts. Circulation 101:510–515

    PubMed  CAS  Google Scholar 

  6. Bruns HJ, Eckardt L, Vahlhaus C et al (2002) Body surface potential mapping in patients with Brugada syndrome: right precordial ST segment variations and reverse changes in left precordial leads. Cardiovasc Res 54:58–66

    Article  PubMed  CAS  Google Scholar 

  7. Miyazaki T, Mitamura H, Miyoshi S et al (1996) Autonomic and antiarrhythmic drug modulation of ST-segment elevation in patients with Brugada syndrome. J Am Coll Cardiol 27:1061–1070

    Article  PubMed  CAS  Google Scholar 

  8. Wichter T, Matheja P, Eckardt L et al (2002) Cardiac autonomic dysfunction in Brugada syndrome. Circulation 105:702–706

    Article  PubMed  Google Scholar 

  9. Kies P, Wichter T, Schafers M et al (2004) Abnormal myocardial presynaptic norepinephrine recycling in patients with Brugada syndrome. Circulation 110:3017–3922

    Article  PubMed  CAS  Google Scholar 

  10. Antzelevitch C, Brugada P, Brugada J et al (2003) Brugada syndrome: 1992–2002. A historical perspective. J Am Coll Cardiol 41:1665–1671

    Article  PubMed  Google Scholar 

  11. Wolpert C, Echternach C, Veltmann C et al (2005) Intravenous drug challenge using flecainide and ajmaline in patients with Brugada syndrome. Heart Rhythm 2:254–260

    Article  PubMed  Google Scholar 

  12. Eckardt L, Bruns HJ, Paul M et al (2002) Body surface area of ST elevation and the presence of late potentials correlate to the inducibility of ventricular tachyarrhythmias in Brugada syndrome. J Cardiovasc Electrophysiol 13:742–749

    Article  PubMed  Google Scholar 

  13. Brugada J, Brugada R, Antzelevitch C et al (2002) Long-term follow-up of individuals with the electrocardiographic pattern of right bundle branch block and ST-segment elevation in precordial leads V1 to V3. Circulation 105:73–78

    Article  PubMed  Google Scholar 

  14. Priori SG, Napolitano C, Gasparini M et al (2002) Natural history of Brugada syndrome: insights for risk stratification and management. Circulation 105:1342–1347

    Article  PubMed  Google Scholar 

  15. Hong K, Brugada J, Oliva A et al (2004) Value of electrocardiographic parameters and ajmaline test in the diagnosis of Brugada syndrome caused by SCN5A mutations. Circulation 110:3023–3027

    Article  PubMed  Google Scholar 

  16. Smits JPP, Eckardt L, Probst V et al (2002) Genotype-phenotype relationship in Brugada syndrome: electrocardiographic features differentiate SCN5A-related patients from non-SCN5A-related patients. J Am Coll Cardiol 40:350–356

    Article  PubMed  CAS  Google Scholar 

  17. Rolf S, Bruns HJ, Wichter T et al (2003) The ajmaline challenge in Brugada syndrome: diagnostic impact, safety, and recommende protocol. Eur Heart J 24:1104–1112

    Article  PubMed  CAS  Google Scholar 

  18. Eckardt L, Probst V, Smits JPP et al (2005) Long-term prognosis of individuals with right precordial ST-segment elevation Brugada syndrome. Circulation 111:257–263

    Article  PubMed  Google Scholar 

  19. Kanda M, Shimizu W, Matsno K et al (2002) Electrophysiologic characteristics and implications of induced ventricular fibrillation in symptomatic patients with Brugada syndrome. J Am Coll Cardiol 39:1799–1805

    Article  PubMed  Google Scholar 

  20. Eckardt L, Kirchhof P, Schulze-Bahr E et al (2002) Electrophysiologic investigation in Brugada syndrome: yield of programmed ventricular stimulation at two ventricular sites with three premature beats. Eur Heart J 23:1394–1401

    Article  PubMed  CAS  Google Scholar 

  21. Brugada J, Brugada R, Brugada P (2003) Determinants of sudden cardiac death in patients with the electrocardiographic pattern of Brugada syndrome and no previous cardiac arrest. Circulation 108:3092–3096

    Article  PubMed  Google Scholar 

  22. Gasparini M, Priori SG, Mantica M et al (2003) Flecainide test in Brugada syndrome: a reproducible but risky tool. Pacing Clin Electrophysiol 26:338–341

    Article  PubMed  Google Scholar 

  23. Shimizu W, Antzelevitch C, Suyama K et al (2000) Effects of sodium channel blockers on ST segment, QRS duration, and corrected QT interval in patients with Brugada syndrome. J Cardiovasc Electrophysiol 11:1320–1329

    Article  PubMed  CAS  Google Scholar 

  24. Fish JM, Antzelevitch C (2004) Role of sodium and calcium channel block in unmasking the Brugada syndrome. Heart Rhythm 1:210–217

    Article  PubMed  Google Scholar 

  25. Roden DM (1994) Risks and benefits of antiarrhythmic therapy. N Engl J Med 331:785–791

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2006 Springer-Verlag Italia

About this chapter

Cite this chapter

Wichter, T., Schulze-Bahr, E., Paul, M., Breithardt, G., Eckardt, L. (2006). Drug Challenge in Brugada Syndrome: How Valuable Is It?. In: Raviele, A. (eds) Cardiac Arrhythmias 2005. Springer, Milano. https://doi.org/10.1007/88-470-0371-7_38

Download citation

  • DOI: https://doi.org/10.1007/88-470-0371-7_38

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0370-5

  • Online ISBN: 978-88-470-0371-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics