Brugada syndrome risk factors: Difference between revisions

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*[[Cocaine]]
*[[Cocaine]]
*[[Fever]]<ref name="pmid12494608">{{cite journal| author=Antzelevitch C, Brugada R| title=Fever and Brugada syndrome. | journal=Pacing Clin Electrophysiol | year= 2002 | volume= 25 | issue= 11 | pages= 1537-9 | pmid=12494608 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12494608  }} </ref>. It is for this reason that [[antipyretic]] agents are recommended to aggressively treat a fever in the patient with Brugada syndrome.
*[[Fever]]<ref name="pmid12494608">{{cite journal| author=Antzelevitch C, Brugada R| title=Fever and Brugada syndrome. | journal=Pacing Clin Electrophysiol | year= 2002 | volume= 25 | issue= 11 | pages= 1537-9 | pmid=12494608 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12494608  }} </ref>. It is for this reason that [[antipyretic]] agents are recommended to aggressively treat a fever in the patient with Brugada syndrome.
*[[Flecainide]]<ref name="pmid10750126">{{cite journal| author=Brugada P, Brugada J, Brugada R| title=Arrhythmia induction by antiarrhythmic drugs. | journal=Pacing Clin Electrophysiol | year= 2000 | volume= 23 | issue= 3 | pages= 291-2 | pmid=10750126 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10750126  }} </ref> (a diagnostic test agent)
*[[Flecainide]]<ref name="pmid10750126">{{cite journal| author=Brugada P, Brugada J, Brugada R| title=Arrhythmia induction by antiarrhythmic drugs. | journal=Pacing Clin Electrophysiol | year= 2000 | volume= 23 | issue= 3 | pages= 291-2 | pmid=10750126 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10750126 }} </ref><ref name="pmid10090224">{{cite journal| author=Fujiki A, Usui M, Nagasawa H, Mizumaki K, Hayashi H, Inoue H| title=ST segment elevation in the right precordial leads induced with class IC antiarrhythmic drugs: insight into the mechanism of Brugada syndrome. | journal=J Cardiovasc Electrophysiol | year= 1999 | volume= 10 | issue= 2 | pages= 214-8 | pmid=10090224 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10090224 }} </ref> (a diagnostic test agent)
*[[Hypercalcemia]]<ref name="pmid6475795">{{cite journal| author=Douglas PS, Carmichael KA, Palevsky PM| title=Extreme hypercalcemia and electrocardiographic changes. | journal=Am J Cardiol | year= 1984 | volume= 54 | issue= 6 | pages= 674-5 | pmid=6475795 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6475795  }} </ref><ref name="pmid6475794">{{cite journal| author=Sridharan MR, Horan LG| title=Electrocardiographic J wave of hypercalcemia. | journal=Am J Cardiol | year= 1984 | volume= 54 | issue= 6 | pages= 672-3 | pmid=6475794 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6475794  }} </ref>
*[[Hypercalcemia]]<ref name="pmid6475795">{{cite journal| author=Douglas PS, Carmichael KA, Palevsky PM| title=Extreme hypercalcemia and electrocardiographic changes. | journal=Am J Cardiol | year= 1984 | volume= 54 | issue= 6 | pages= 674-5 | pmid=6475795 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6475795  }} </ref><ref name="pmid6475794">{{cite journal| author=Sridharan MR, Horan LG| title=Electrocardiographic J wave of hypercalcemia. | journal=Am J Cardiol | year= 1984 | volume= 54 | issue= 6 | pages= 672-3 | pmid=6475794 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6475794  }} </ref>
*[[Hyperkalemia]]<ref name="pmid15427197">{{cite journal| author=MYERS GB| title=Other QRS-T patterns that may be mistaken for myocardial infarction; IV. alterations in blood potassium; myocardial ischemia; subepicardial myocarditis; distortion associated with arrhythmias. | journal=Circulation | year= 1950 | volume= 2 | issue= 1 | pages= 75-93 | pmid=15427197 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15427197  }} </ref><ref name="pmid14771753">{{cite journal| author=MERRILL JP, LEVINE HD, SOMERVILLE W, SMITH S| title=Clinical recognition and treatment of acute potassium intoxication. | journal=Ann Intern Med | year= 1950 | volume= 33 | issue= 4 | pages= 797-830 | pmid=14771753 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14771753  }} </ref><ref name="pmid12413761">{{cite journal| author=Ortega-Carnicer J, Benezet J, Ruiz-Lorenzo F, Alcázar R| title=Transient Brugada-type electrocardiographic abnormalities in renal failure reversed by dialysis. | journal=Resuscitation | year= 2002 | volume= 55 | issue= 2 | pages= 215-9 | pmid=12413761 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12413761  }} </ref>
*[[Hyperkalemia]]<ref name="pmid15427197">{{cite journal| author=MYERS GB| title=Other QRS-T patterns that may be mistaken for myocardial infarction; IV. alterations in blood potassium; myocardial ischemia; subepicardial myocarditis; distortion associated with arrhythmias. | journal=Circulation | year= 1950 | volume= 2 | issue= 1 | pages= 75-93 | pmid=15427197 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15427197  }} </ref><ref name="pmid14771753">{{cite journal| author=MERRILL JP, LEVINE HD, SOMERVILLE W, SMITH S| title=Clinical recognition and treatment of acute potassium intoxication. | journal=Ann Intern Med | year= 1950 | volume= 33 | issue= 4 | pages= 797-830 | pmid=14771753 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14771753  }} </ref><ref name="pmid12413761">{{cite journal| author=Ortega-Carnicer J, Benezet J, Ruiz-Lorenzo F, Alcázar R| title=Transient Brugada-type electrocardiographic abnormalities in renal failure reversed by dialysis. | journal=Resuscitation | year= 2002 | volume= 55 | issue= 2 | pages= 215-9 | pmid=12413761 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12413761  }} </ref>

Revision as of 18:52, 14 October 2012

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The EKG changes of Brugada syndrome can vary over time, depending on the autonomic balance and the administration of antiarrhythmic drugs. Adrenergic stimulation decreases the ST segment elevation, while vagal stimulation worsens it. During sleep, there is heightened vagal tone, and the pattern may be exacerbated at that time (as is the risk of sudden cardiac death at that time). The administration of class Ia, Ic and III drugs increases the ST segment elevation, as does fever. The impact of exercise depends upon when the EKG is obtained: during exercise the ST segment elevation may decrease but may increase later after exercise when the body temperature has risen. Similar to early repolarization variant, when the heart rate decreases, the ST segment elevation increases and when the heart rate increases the ST segment elevation decreases.

Risk Factors: Agents and Scenarios that Provoke the Brugada Syndrome Pattern

The electrocardiographic findings of Brugada syndrome are often concealed, but can be unmasked or modulated by a number of drugs and pathophysiological states including (in alphabetical order)[1]:

Risk Statification

  • Patients with syncope and an abnormal Type 1 ECG are at higher risk
  • Asymptomatic patients at risk can be identified
    • Presence of spontaneous Type 1 ST-segment elevation
    • Characteristics of the S wave
    • Presence of late potentials
    • Inducibility of VT/VF using PES is controversial as a risk factor. Some groups have advocated that programmed electrical stimulation (PES) be performed to induce ventricular fibrillation for risk assessment in Brugada patients [13][14]

Other groups have not reproduced the predictive value of these tests,[15][16] so the value of programmed electrical stimulation (PES) and inducibility remains controversial.

References

  1. ↑ Antzelevitch C, Brugada P, Borggrefe M, Brugada J, Brugada R, Corrado D, Gussak I, LeMarec H, Nademanee K, Perez Riera AR, Shimizu W, Schulze-Bahr E, Tan H, Wilde A (2005). "Brugada syndrome: report of the second consensus conference". Heart Rhythm : the Official Journal of the Heart Rhythm Society. 2 (4): 429–40. PMID 15898165. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  2. ↑ 2.0 2.1 2.2 Miyazaki T, Mitamura H, Miyoshi S, Soejima K, Aizawa Y, Ogawa S (1996). "Autonomic and antiarrhythmic drug modulation of ST segment elevation in patients with Brugada syndrome". J Am Coll Cardiol. 27 (5): 1061–70. doi:10.1016/0735-1097(95)00613-3. PMID 8609322.
  3. ↑ 3.0 3.1 3.2 3.3 Brugada P, Brugada J, Brugada R (2000). "Arrhythmia induction by antiarrhythmic drugs". Pacing Clin Electrophysiol. 23 (3): 291–2. PMID 10750126.
  4. ↑ Antzelevitch C, Brugada R (2002). "Fever and Brugada syndrome". Pacing Clin Electrophysiol. 25 (11): 1537–9. PMID 12494608.
  5. ↑ Fujiki A, Usui M, Nagasawa H, Mizumaki K, Hayashi H, Inoue H (1999). "ST segment elevation in the right precordial leads induced with class IC antiarrhythmic drugs: insight into the mechanism of Brugada syndrome". J Cardiovasc Electrophysiol. 10 (2): 214–8. PMID 10090224.
  6. ↑ Douglas PS, Carmichael KA, Palevsky PM (1984). "Extreme hypercalcemia and electrocardiographic changes". Am J Cardiol. 54 (6): 674–5. PMID 6475795.
  7. ↑ Sridharan MR, Horan LG (1984). "Electrocardiographic J wave of hypercalcemia". Am J Cardiol. 54 (6): 672–3. PMID 6475794.
  8. ↑ MYERS GB (1950). "Other QRS-T patterns that may be mistaken for myocardial infarction; IV. alterations in blood potassium; myocardial ischemia; subepicardial myocarditis; distortion associated with arrhythmias". Circulation. 2 (1): 75–93. PMID 15427197.
  9. ↑ MERRILL JP, LEVINE HD, SOMERVILLE W, SMITH S (1950). "Clinical recognition and treatment of acute potassium intoxication". Ann Intern Med. 33 (4): 797–830. PMID 14771753.
  10. ↑ Ortega-Carnicer J, Benezet J, Ruiz-Lorenzo F, Alcázar R (2002). "Transient Brugada-type electrocardiographic abnormalities in renal failure reversed by dialysis". Resuscitation. 55 (2): 215–9. PMID 12413761.
  11. ↑ Brugada R, Brugada J, Antzelevitch C, Kirsch GE, Potenza D, Towbin JA; 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 (5): 510–5. PMID 10662748.
  12. ↑ Shimizu W, Antzelevitch C, Suyama K, Kurita T, Taguchi A, Aihara N; et al. (2000). "Effect of sodium channel blockers on ST segment, QRS duration, and corrected QT interval in patients with Brugada syndrome". J Cardiovasc Electrophysiol. 11 (12): 1320–9. PMID 11196553.
  13. ↑ Brugada J, Brugada R, Antzelevitch C, Towbin J, Nademanee K, Brugada P (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 (1): 73–8. PMID 11772879. Retrieved 2012-10-13. Unknown parameter |month= ignored (help)
  14. ↑ Brugada P, Brugada R, Mont L, Rivero M, Geelen P, Brugada J (2003). "Natural history of Brugada syndrome: the prognostic value of programmed electrical stimulation of the heart". Journal of Cardiovascular Electrophysiology. 14 (5): 455–7. PMID 12776858. Retrieved 2012-10-13. Unknown parameter |month= ignored (help)
  15. ↑ Priori SG, Napolitano C, Gasparini M, Pappone C, Della Bella P, Giordano U, Bloise R, Giustetto C, De Nardis R, Grillo M, Ronchetti E, Faggiano G, Nastoli J (2002). "Natural history of Brugada syndrome: insights for risk stratification and management". Circulation. 105 (11): 1342–7. PMID 11901046. Retrieved 2012-10-13. Unknown parameter |month= ignored (help)
  16. ↑ Eckardt L, Probst V, Smits JP, Bahr ES, Wolpert C, Schimpf R, Wichter T, Boisseau P, Heinecke A, Breithardt G, Borggrefe M, LeMarec H, Böcker D, Wilde AA (2005). "Long-term prognosis of individuals with right precordial ST-segment-elevation Brugada syndrome". Circulation. 111 (3): 257–63. doi:10.1161/01.CIR.0000153267.21278.8D. PMID 15642768. Retrieved 2012-10-13. Unknown parameter |month= ignored (help)

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