Arrhythmic Storm Responsive to Quinidine in a Patient with Brugada Syndrome and Vasovagal Syncope

Abstract

A 37-year-old man with Brugada syndrome (BrS) and arrhythmic storm is described. One month after implantation of a cardioverter-defibrillator he presented with recurrent appropriate shocks for spontaneous ventricular fibrillation (VF). Because of this arrhythmic storm, quinidine therapy was initiated with total suppression of all spontaneous arrhythmias. He had remained free of arrhythmias for 22 months since quinidine initiation. Two episodes of VF occurred after the patient stopped taking the medication. The patient resumed quinidine and has been free of VF for the last 3 months. This response to quinidine in a patient with symptomatic BrS supports its role in the prophylaxis of arrhythmic events in BrS.

Clinical spectrum of patients with a Brugada ECG

“…Low dose intravenous isoproterenol has been reported to suppress arrhythmic storm in BrS [73][74][75]. Additionally, oral quinidine therapy can be used if arrhythmia is persistent [76]. In the rare case of failure of these therapeutic options, radiofrequency-catheter ablation of the ventricular ectopic foci can be attempted, but should be regarded as a highly specialized modality [77,78].…”

The Brugada syndrome

“…Lowdose intravenous isoproterenol has been reported to suppress arrhythmic storms in BrS [70][71][72]. Additionally, oral quinidine therapy can be started if arrhythmic storms cannot be controlled [73]. In case of failure of these therapeutic options, radiofrequency-catheter ablation of the triggering ventricular ectopies can be attempted, but should be regarded as a highly specialized 'ultimate stage' treatment [74,75].…”

Drug Therapy in Brugada Syndrome

“…In both cases, ST segment was normalized after achieving therapeutic plasma concentrations of quinidine. A patient with BrS seen at our Institution presented 3 episodes of spontaneous VF within a 7-hour period (thus fulfilling the criteria for arrhythmic storm) one month after an ICD was implanted [44]. Quinidine sulfate 200 mg B.I.D.…”