Acute and chronic management in patients with Brugada syndrome associated with electrical storm of ventricular fibrillation

Part 8: Advanced Life Support

“…393,394 Polymorphic wide-complex tachycardia associated with acute myocardial ischemia responded to IV ␤-blockers in a modestly sized study (LOE 3) 369 ; however, there was no benefit from IV magnesium in a small study (LOE 3). 384 A LOE-4 study 395 and extrapolation from a small case series suggested that isoproterenol attenuated the ST elevation associated with Brugada syndrome (LOE 5). 396 Extrapolation from 1 case series suggested worsened Brugada ST elevation with class IA antiarrhythmics (LOE 5).…”

Drug-Induced Arrhythmia

“…Inhibition of the Na ϩ / Ca 2ϩ exchanger has been recently shown to reduce action potential duration, early afterdepolarizations, and TdP in the setting of both HERG-blocking and SCN5A-activating drugs (mimicking LQT2 and LQT3, respectively). 81 Other examples of beneficial drug effects include reports suggesting that quinidine may ameliorate the ECG phenotype and arrhythmic risk of patients with Brugada syndrome via quinidine-induced I to blockade 82,83 and may effectively treat (by I Kr blockade) the gain-of-function mutation in I Kr associated with 1 form of the congenital short-QT syndrome, 84 as well as the use of mexiletine or flecainide as a treatment for congenital LQT3. [85][86][87] …”

A Case of Brugada Syndrome Presenting With Incessant Polymorphic Ventricular Tachycardia

“…Thus, tedisamil may be more potent than quinidine in Brugada syndrome. 2,3,6 Other agents that can be considered include β-adrenergic agonists (isoproterenol) and phosphodiesterase III inhibitors (cilostazol). Isoproterenol stimulates cyclic adenosine monophosphate formation which boosts the ICa current.…”