Brugada syndrome risk factors: Difference between revisions

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Revision as of 01:37, 14 October 2012

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

Overview

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]:

A combination of glucose and insulin
Ajmaline (a diagnostic test agent)
α-adrenergic agonists
β-adrenergic blockers
Cocaine
Fever
Flecainide (a diagnostic test agent)
Hypercalcemia
Hyperkalemia
Hypokalemia
In large studies, a family history of sudden cardiac death among patients with Brugada syndrome does not appear to be a risk factor for sudden cardiac death in siblings.
Procainamide (a diagnostic test agent)
Propranolol intoxication
Sodium channel blockers (a diagnostic test agent)
Tetracyclic antidepressants
Tricyclic antidepressants
Vagotonic agents that mimic sleep

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 ^[2]^[3]

Other groups have not reproduced the predictive value of these tests,^[4]^[5] so the value of programmed electrical stimulation (PES) and inducibility remains controversial.

References

↑ 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)
↑ 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)
↑ 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)
↑ 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)
↑ 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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[pmid15898165-1] 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)

[pmid11772879-2] 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)

[pmid12776858-3] 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)

[pmid11901046-4] 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)

[pmid15642768-5] 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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@@ Line 32: / Line 32: @@
 ** Characteristics of the S wave
 ** Presence of late potentials
-** Inducibility of [[VT]]/[[VF]] using PES is controversial as a risk factor.
+** 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 <ref name="pmid11772879">{{cite journal |author=Brugada J, Brugada R, Antzelevitch C, Towbin J, Nademanee K, Brugada P |title=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 |journal=[[Circulation]] |volume=105 |issue=1 |pages=73–8 |year=2002 |month=January |pmid=11772879 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=11772879 |issn= |accessdate=2012-10-13}}</ref><ref name="pmid12776858">{{cite journal |author=Brugada P, Brugada R, Mont L, Rivero M, Geelen P, Brugada J |title=Natural history of Brugada syndrome: the prognostic value of programmed electrical stimulation of the heart |journal=[[Journal of Cardiovascular Electrophysiology]] |volume=14 |issue=5 |pages=455–7 |year=2003 |month=May |pmid=12776858 |doi= |url=http://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1045-3873&date=2003&volume=14&issue=5&spage=455 |issn= |accessdate=2012-10-13}}</ref>
+Other groups have not reproduced the predictive value of these tests,<ref name="pmid11901046">{{cite journal |author=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 |title=Natural history of Brugada syndrome: insights for risk stratification and management |journal=[[Circulation]] |volume=105 |issue=11 |pages=1342–7 |year=2002 |month=March |pmid=11901046 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=11901046 |issn= |accessdate=2012-10-13}}</ref><ref name="pmid15642768">{{cite journal |author=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 |title=Long-term prognosis of individuals with right precordial ST-segment-elevation Brugada syndrome |journal=[[Circulation]] |volume=111 |issue=3 |pages=257–63 |year=2005 |month=January |pmid=15642768 |doi=10.1161/01.CIR.0000153267.21278.8D |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15642768 |issn= |accessdate=2012-10-13}}</ref> so the value of programmed electrical stimulation (PES) and inducibility remains controversial.
 ==References==