Brugada syndrome treatment: Difference between revisions
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* [[Quinidine]] reduces the number of [[VF]] episodes and corrects spontaneous ECG changes, possibly via inhibiting I(to) channels. No drug has demonstrated long term efficacy in the prevention of [[sudden cardiac death]].<ref name="pmid15381640">{{cite journal |author=Belhassen B, Glick A, Viskin S |title=Efficacy of quinidine in high-risk patients with Brugada syndrome |journal=Circulation |volume=110 |issue=13 |pages=1731–7 |year=2004 |pmid=15381640 |doi=10.1161/01.CIR.0000143159.30585.90}}</ref><ref name="TsuchiyaAshikaga2002">{{cite journal|last1=Tsuchiya|first1=Takeshi|last2=Ashikaga|first2=Keiichi|last3=Honda|first3=Toshihiro|last4=Arita|first4=Makoto|title=Prevention of Ventricular Fibrillation by Cilostazol, an Oral Phosphodiesterase Inhibitor, in a Patient with Brugada Syndrome|journal=Journal of Cardiovascular Electrophysiology|volume=13|issue=7|year=2002|pages=698–701|issn=1045-3873|doi=10.1046/j.1540-8167.2002.00698.x}}</ref><ref name="AbudBagattin2006">{{cite journal|last1=Abud|first1=Atilio|last2=Bagattin|first2=Daniel|last3=Goyeneche|first3=Raul|last4=Becker|first4=Carlos|title=Failure of Cilostazol in the Prevention of Ventricular Fibrillation in a Patient with Brugada Syndrome|journal=Journal of Cardiovascular Electrophysiology|volume=17|issue=2|year=2006|pages=210–212|issn=1045-3873|doi=10.1111/j.1540-8167.2005.00290.x}}</ref><ref name="MatsuiKiyosue1999">{{cite journal|last1=Matsui|first1=Kazunori|last2=Kiyosue|first2=Tatsuto|last3=Wang|first3=Jin-Cheng|last4=Dohi|first4=Kazuhiro|last5=Arita|first5=Makoto|journal=Cardiovascular Drugs and Therapy|volume=13|issue=2|year=1999|pages=105–113|issn=09203206|doi=10.1023/A:1007779908346}}</ref><ref name="MiyazakiMitamura1996">{{cite journal|last1=Miyazaki|first1=Toshihisa|last2=Mitamura|first2=Hideo|last3=Miyoshi|first3=Shunichiro|last4=Soejima|first4=Kyoko|last5=Aizawa|first5=Yoshifusa|last6=Ogawa|first6=Satoshi|title=Autonomic and antiarrhythmic drug modulation of ST segment elevation in patients with Brugada syndrome|journal=Journal of the American College of Cardiology|volume=27|issue=5|year=1996|pages=1061–1070|issn=07351097|doi=10.1016/0735-1097(95)00613-3}}</ref><ref name="SuzukiTorigoe2000">{{cite journal|last1=Suzuki|first1=Hiroshi|last2=Torigoe|first2=Katsumi|last3=Numata|first3=Osamu|last4=Yazaki|first4=Satoshi|title=Infant Case with a Malignant Form of Brugada Syndrome|journal=Journal of Cardiovascular Electrophysiology|volume=11|issue=11|year=2000|pages=1277–1280|issn=1045-3873|doi=10.1046/j.1540-8167.2000.01277.x}}</ref> | * [[Quinidine]] reduces the number of [[VF]] episodes and corrects spontaneous ECG changes, possibly via inhibiting I(to) channels. No drug has demonstrated long term efficacy in the prevention of [[sudden cardiac death]].<ref name="pmid15381640">{{cite journal |author=Belhassen B, Glick A, Viskin S |title=Efficacy of quinidine in high-risk patients with Brugada syndrome |journal=Circulation |volume=110 |issue=13 |pages=1731–7 |year=2004 |pmid=15381640 |doi=10.1161/01.CIR.0000143159.30585.90}}</ref><ref name="TsuchiyaAshikaga2002">{{cite journal|last1=Tsuchiya|first1=Takeshi|last2=Ashikaga|first2=Keiichi|last3=Honda|first3=Toshihiro|last4=Arita|first4=Makoto|title=Prevention of Ventricular Fibrillation by Cilostazol, an Oral Phosphodiesterase Inhibitor, in a Patient with Brugada Syndrome|journal=Journal of Cardiovascular Electrophysiology|volume=13|issue=7|year=2002|pages=698–701|issn=1045-3873|doi=10.1046/j.1540-8167.2002.00698.x}}</ref><ref name="AbudBagattin2006">{{cite journal|last1=Abud|first1=Atilio|last2=Bagattin|first2=Daniel|last3=Goyeneche|first3=Raul|last4=Becker|first4=Carlos|title=Failure of Cilostazol in the Prevention of Ventricular Fibrillation in a Patient with Brugada Syndrome|journal=Journal of Cardiovascular Electrophysiology|volume=17|issue=2|year=2006|pages=210–212|issn=1045-3873|doi=10.1111/j.1540-8167.2005.00290.x}}</ref><ref name="MatsuiKiyosue1999">{{cite journal|last1=Matsui|first1=Kazunori|last2=Kiyosue|first2=Tatsuto|last3=Wang|first3=Jin-Cheng|last4=Dohi|first4=Kazuhiro|last5=Arita|first5=Makoto|journal=Cardiovascular Drugs and Therapy|volume=13|issue=2|year=1999|pages=105–113|issn=09203206|doi=10.1023/A:1007779908346}}</ref><ref name="MiyazakiMitamura1996">{{cite journal|last1=Miyazaki|first1=Toshihisa|last2=Mitamura|first2=Hideo|last3=Miyoshi|first3=Shunichiro|last4=Soejima|first4=Kyoko|last5=Aizawa|first5=Yoshifusa|last6=Ogawa|first6=Satoshi|title=Autonomic and antiarrhythmic drug modulation of ST segment elevation in patients with Brugada syndrome|journal=Journal of the American College of Cardiology|volume=27|issue=5|year=1996|pages=1061–1070|issn=07351097|doi=10.1016/0735-1097(95)00613-3}}</ref><ref name="SuzukiTorigoe2000">{{cite journal|last1=Suzuki|first1=Hiroshi|last2=Torigoe|first2=Katsumi|last3=Numata|first3=Osamu|last4=Yazaki|first4=Satoshi|title=Infant Case with a Malignant Form of Brugada Syndrome|journal=Journal of Cardiovascular Electrophysiology|volume=11|issue=11|year=2000|pages=1277–1280|issn=1045-3873|doi=10.1046/j.1540-8167.2000.01277.x}}</ref> | ||
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| colspan="1" style="text-align:center; background:LightGreen" Pharmacological tests using a sodium-channel blocker drug should be used to evaluate suspected Brugada syndrome. Intravenous ajmaline and flecainide are the most widely used agents. The test is considered positive if a type 1 ECG pattern is identified during drug infusion.|} | |||
*Pharmacological tests using a sodium-channel blocker drug should be used to evaluate suspected Brugada syndrome. Intravenous ajmaline and flecainide are the most widely used agents. The test is considered positive if a type 1 ECG pattern is identified during drug infusion. | *Pharmacological tests using a sodium-channel blocker drug should be used to evaluate suspected Brugada syndrome. Intravenous ajmaline and flecainide are the most widely used agents. The test is considered positive if a type 1 ECG pattern is identified during drug infusion. | ||
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* Recommendation: Class I: convincing evidence/opinion; Class IIa: evidence/opinion less clear; Class IIb: conflicting evidence/opinion; Class III: very little evidence. | * Recommendation: Class I: convincing evidence/opinion; Class IIa: evidence/opinion less clear; Class IIb: conflicting evidence/opinion; Class III: very little evidence. | ||
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==Treatment of VT Storm== | ==Treatment of VT Storm== | ||
Revision as of 16:19, 23 December 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Implantation of a cardiac defibrillator is the only proven method of treatment in Brugada syndrome.Patients with aborted sudden cardiac death are at high risk for recurrence and should undergo AICD implantation, and do not require an electrophysiologic study to assess inducibility. Patients with symptoms (either syncope, seizures or nocturnal agonal respirations) should undergo implantation of a defibrillator if no other cause of their symptoms can be identified. Asymptomatic patients should undergo electrophysiologic testing, and if VT / VF can be induced, they should undergo implantation of an ICD. Asymptomatic patients who cannot be induced should followed-up closely. Patients who are asymptomatic with no family history of Brugada syndrome can be followed-up closely.
The Two Patient Groups
The 2005 consensus statement divides patients into two groups:
- Higher risk patients with spontaneous Type I Brugada pattern
- A less high risk cohort of patients who require infusion of a sodium channel blocker to induce a Type I Brugada pattern.
The management of these two groups of patients will be discussed separately.
Management of Patients with a Spontaneous Type I Brugada Pattern
Implantation of a cardiac defibrillator should be considered in the following patients:
Symptomatic Patients
- Patients with aborted sudden cardiac death
- Patients with syncope, seizures or nocturnal agonal respirations who have no other identifiable cause for their symptoms
The flowchart below summarizes the recommendations of the 2005 consensus panel:
Asymptomatic Patients
- Patients with a family history of sudden cardiac death that is suspected to be due to Brugada syndrome in whom VT VF can be induced on electrophysiologic testing.
- Patients with no family history of sudden cardiac death in whom VT VF can be induced on electrophysiologic testing.
In essence, if VT VF can be induced on electrophysiologic testing in these patients, a cardiac defibrillator should be implanted. It is unclear if the same recommendations apply to those patients who require that the electrodes be placed one to two intercostal spaces higher to demonstrate a Brugada type I electrocardiographic pattern.
The flowchart below summarizes the recommendations of the 2005 consensus panel:
Management of Patients with a Sodium Channel Induced Type I Brugada Pattern
Implantation of a cardiac defibrillator should be considered in the following patients:
Symptomatic Patients
- Patients with aborted sudden cardiac death
- Patients with syncope, seizures or nocturnal agonal respirations who have no other identifiable cause for their symptoms
The flowchart below summarizes the recommendations of the 2005 consensus panel:
Asymptomatic Patients
- Patients with a family history of sudden cardiac death that is suspected to be due to Brugada syndrome in whom VT VF can be induced on electrophysiologic testing.
The flowchart below summarizes the recommendations of the 2005 consensus panel.
Pharmacotherapy
- Pharmacotherapy alone may not be sufficient to treat Brugada syndrome, but it may be required in regions of the world where ICD implantation is cost prohibitive or in infants.[1]
- Quinidine reduces the number of VF episodes and corrects spontaneous ECG changes, possibly via inhibiting I(to) channels. No drug has demonstrated long term efficacy in the prevention of sudden cardiac death.[2][3][4][5][6][7]
}
Drugs with Potential Antiarrhythmic Effect(Alphabetical order generic name)
Treatment of VT Storm
Treatment of Coronary Ischemia
Treatment of Factors that may Precipitate Brugada Type EKG Changes and Clinical Symptoms
Contraindicated medicationsBrugada syndrome is considered an absolute contraindication to the use of the following medications: ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (DO NOT EDIT) [8]Recommendations for Brugada Syndrome
References
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