Cogprints

Role of pharmacotherapy in Brugada syndrome

Tsuchiya, Takeshi (2004) Role of pharmacotherapy in Brugada syndrome. [Journal (Paginated)]

Full text available as:

[img]HTML
39Kb
[img]
Preview
PDF
69Kb

Abstract

In patients who undergo aborted sudden cardiac death or syncope of unknown origin (symptomatic Brugada syndrome), no one argues that the implantation of an ICD is the first-line therapy regardless of the findings of the EP study. For those patients, drug therapy plays not a contradictory but a complimentary role to the ICD by reducing the number of ICD shock deliveries. Prevention of VF contributes to the improvement in the quality of life of the patients by avoiding uncomfortable ICD shock deliveries. As mentioned above, Belhassen et al. 11, performed EP-guided medical therapy in 34 patients with idiopathic VF, in 5 of whom the criterion of Brugada syndrome were fulfilled, and reported excellent long-term results. Although medical therapy requires markers that can accurately predict the preventive effect of VF over a long-term period, there, however, seems to be no reliable marker. An EP study is usually used to examine the preventive effects of antiarrhythmic agents on sustained ventricular tachycardia in patients with structural heart disease, whereas the prognostic value of the EP study in predicting life-threatening events in Brugada syndrome is still controversial. Brugada et al., 3 suggested that among the asymptomatic patients, the inducibility of VT during the EP study might be a prognostic marker of risk. Studies by Priori et al., 22 and Kanda et al., 23 failed to find an association between the inducibility and recurrence of VT/VF in patients with Brugada syndrome regardless of whether it was symptomatic or asymptomatic. As Belhassen suggested 13, the difference might be due to the VF induction protocol in the EP study, in which Belhassen et al., used a stimulus current intensity of five times the diastolic threshold along with the use of repetition of double and triple extrastimulation at the shortest coupling intervals that resulted in ventricular capture. Further appropriate clinical trials are needed to clarify this issue. In patients with asymptomatic Brugada syndrome who are family members of symptomatic Brugada syndrome patients, the same strategy as that for the symptomatic Brugada syndrome patients should be considered 2,3,4. In another asymptomatic-patient group in whom an ECG that discloses the Brugada sign is performed for routine reasons such as a workup prior to surgery or sport license or screening for insurance, risk stratification to find the patients at high risk is needed because in most cases these patients have a benign prognosis3,22,23. Antzelevitch et al. 4, recommended that all asymptomatic patients with the Brugada sign should undergo an EP study for risk stratification, and, if inducible, an ICD should be implanted since Brugada et al.3, reported that an overall 8% life-threatening event rate was found in initially asymptomatic patients. Belhassen et al.,13 suggested that EP study-guided quinidine therapy might become an alternative to ICD therapy for prophylaxis of arrhythmic events in these patients. Further appropriate clinical trials are needed.

Item Type:Journal (Paginated)
Keywords:brugada syndrome; pharmacotherapy
Subjects:JOURNALS > Indian Pacing and Electrophysiology Journal
ID Code:4236
Deposited By:Indian Pacing and Electrophysiology, Journal
Deposited On:17 Apr 2005
Last Modified:11 Mar 2011 08:55

References in Article

Select the SEEK icon to attempt to find the referenced article. If it does not appear to be in cogprints you will be forwarded to the paracite service. Poorly formated references will probably not work.

1. Brugada P, Brugada J: Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome. J Am Coll Cardiol 1992;20:1391-1396.

2. Brugada J, Brugada R, Brugada P: right bundle branch block and ST-segment elevation in leads V1 through V3: a marker for sudden death in patients without demonstrable structural heart disease. Circulation 1998;97:457-460

3. Brugada J, Brugada R, Antzelevitch C, Towbin JA, Nademanee K, Brugada P: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 2002;105:73-78.

4. Antzelevitch C, Brugada P, Brugada J, Brugada R, Towbin JA, Nademanee K: Brugada syndrome:1992-2002 a historical review. J Am Coll Cardiol 2003;41:1665-1671.

5. Chen Q, Kirsch GE, Zhang D, Brugada R, Brugada J, Brugada P, Potenza D, Moya A, Borggrefe M, Breithardt G, Oritz-Lopes R, Wang Z, Antzelevitch C, O'Brien RE, Schulze-Bahr E, Keating MT, Towbin JA, Wang Q: Genetic basis and molecular mechanism for idiopathic ventricular fibrillation. Nature 1998;392:293-296

6. Priori SG, Napolitano C, Gasparini M, Pappone C, Bella PD, Brignole M, Giordano U, Giovannini T, Menozzi C, Bloise R, Crotti L, Terreni L, Schwartz PJ: Clinical and genetic heterogeneity of right bundle branch block and ST-segment elevation syndrome: a prospective evaluation of 52 families. Circulation 2000;102:2509-2515

7. Yan GX, Antzelevitch C: Celluar basis for the Brugada syndrome and other mechanisms of arrhythmogenesis associated with ST-segment elevation. Circulation 1999;100:1660-1666

8. Antzelevitch C: The Brugada syndrome: ionic basis and arrhythmia mechanisms. J Caradivasc Electrophysiol 2001;12:268-272

9. Miyazaki T, Mitamura H, Hiyoshi S, Soejima K, Aizawa Y, Ogawa S: Autonomic and antiarrhythmic drug modulation of ST segment elevation in patients with Brugada syndrome. J Am Coll Cardiol 1996;27:1061-1070

10. Chalvidan T, Deharo JC, Dieuzaide P, et al.: Near fatal electrical storm in apatient equipped with an implantable cardioverter-defibrillator for Brugada syndrome. PACE 2000;23:410-412

11. Belhassen B, Viskin S, Fish R, Glick A, Setbon I, Elder M: Effects of electrophysiologic-guided therapy with class IA antiarrhythmic drugs on the long-term outcome of patients with idiopathic ventricular fibrillation with or without the Brugada syndrome. J Cardiovasc Electrophysiol 1999;10:1301-1312

12. Ruskin JN: Idiopathic ventricular fibrillation: is there a role for electrophysiologic-guided antiarrhythmic drug therapy? J Cardiovasc Electrophysiol 1999;10:1313-1315

13. Belhassen B, Viskin S, Antzelevitch C: The Brugada syndrome: is implantable cardioverter defibrillator the only therapeutic option? PACE 2002;25:1634-1640

14. Kurita T, Shimizu W, Inagaki M, et al: The electrophysiologic mechanism of ST-segment elevation in Brugada syndrome. J Am Coll Cardiol 2002;40:330-334

15. Nagase S, Kusano KF, Morita H, et al: Epicardial electrogram at the right ventricular outflow tract in patients with Brugada syndrome using epicardial lead. J Am Coll Cardiol 2002;39:1992-1995

16. Antzelevitch C: Late potentials and the Brugada syndrome. J Am Coll Cardiol 2002;39:1996-1999

17. Shimizu W, Antzelevitch C, Suyama K, Kurita T, Taguchi A, Aihara N, Takaki H, Sunagawa K, Kamakura S: Effect of sodium channel blockers on ST segment, QRS duration, and corrected QT interval in patients with Brugada syndrome. J Cardiovasc Electrophysiol 2000;11:1320-1329

18. Lee KL, Lau CP, Tse HF, Wan SH, Fan K: Prevention of ventricular fibrillation by pacing in a man with Brugada syndrome. J Caradivasc Electrophysiol 2000;11:935-937.

19. Tanaka H, Kinoshita O, Uchikawa S, et al: Successful prevention of recurrent ventricular fibrillation by intravenous Isoproterenol in a patient with Brugada syndrome. PACE 2001;24:1293-1294

20. Matsui K, Kiyosue T, Wang J-C, Dohi K, Arita M: Effects of pimopendan on the L-type Ca2+ current and developed tension in guinea-pig ventricular myocytes and papillary muscle: Comparison with IBMX, milrinone and cilostazol. Cardiovasc Drugs Ther 1999;13:105-113

21. Tsuchiya T, Ashikaga K, Honda T, Arita M: Prevention of ventricular fibrillation by cilostazol, an oral phosphodiesterase inhibitor, in a patient with Brugada syndrome. J Cardiovasc Electrophysiol 2002;13:698-671

22. Priori SG, Napolitano C, Gasparini M, et al: Natural history of Brugada syndrome: insights for risk stratification and management. Circulation 2002;105:1342-1347

23. Kanda M, Shimizu W, Matsuo K, et al: Electrophysiologic characteristics and implications of induced ventricular fibrillation in symptomatic patients with Brugada syndrome. J Am Coll Cardiol 2002;39:1799-1805

Metadata

Repository Staff Only: item control page