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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
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
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
Antzelevitch C, Brugada P, Borggrefe M et al (2005) Brugada syndrome: Report of the second consensus conference. Circulation 111:659–670
Antzelevitch C (2001) The Brugada syndrome: ionic basis and arrhythmia mechanisms. J Cardiovasc Electrophysiol 12:268–272
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
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
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
Wichter T, Matheja P, Eckardt L et al (2002) Cardiac autonomic dysfunction in Brugada syndrome. Circulation 105:702–706
Kies P, Wichter T, Schafers M et al (2004) Abnormal myocardial presynaptic norepinephrine recycling in patients with Brugada syndrome. Circulation 110:3017–3922
Antzelevitch C, Brugada P, Brugada J et al (2003) Brugada syndrome: 1992–2002. A historical perspective. J Am Coll Cardiol 41:1665–1671
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
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
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
Priori SG, Napolitano C, Gasparini M et al (2002) Natural history of Brugada syndrome: insights for risk stratification and management. Circulation 105:1342–1347
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
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
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
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
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
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
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
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
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
Fish JM, Antzelevitch C (2004) Role of sodium and calcium channel block in unmasking the Brugada syndrome. Heart Rhythm 1:210–217
Roden DM (1994) Risks and benefits of antiarrhythmic therapy. N Engl J Med 331:785–791
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights 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)