Brugada syndrome risk factors: Difference between revisions
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*[[Sodium channel blockers]] (a diagnostic test agent) | *[[Sodium channel blockers]] (a diagnostic test agent) | ||
*[[Tetracyclic antidepressants]] | *[[Tetracyclic antidepressants]] | ||
:*[[Amitriptyline]] | |||
:*[[Nortriptyline]] | |||
:*[[Desipramine]] | |||
:*[[Clomipramine]] | |||
*[[Tricyclic antidepressants]] | *[[Tricyclic antidepressants]] | ||
*[[Vagotonic agents]] that mimic sleep | *[[Vagotonic agents]] that mimic sleep | ||
Revision as of 05:00, 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. It is for this reason that antipyretic agents are recommended to aggressively treat a fever in the patient with Brugada syndrome.
- 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)