Unmasking Effect of Propafenone on the Concealed Form of the Brugada Phenomenon

Matana, Ante; Goldner, Vladimir; Stanić, Karlo; Mavrić, Åko; Zaputović, Luka; Matana, Zrinka

doi:10.1111/j.1540-8159.2000.tb06774.x

Cited by 55 publications

(17 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1 More prominent ST-segment elevation in the right precordial leads has been observed immediately before or after episodes of aborted sudden cardiac death in some patients, 2,3 but asymptomatic patients with Bru-ECG have been described. [4][5][6] Brugada et al also reported that the incidence of arrhythmic events is similar in symptomatic and asymptomatic patients with Bru-ECG. 7 These reports suggest that all patients with characteristic Bru-ECG are at risk for sudden cardiac death, but the variety of arrhythmic events associated with the Bru-ECG and the relationship between the occurrence of arrhythmic events and STsegment elevation is unknown.…”

mentioning

confidence: 99%

Arrhythmias in Patients With Brugada-Type Electrocardiographic Findings

et al. 2001

View full text Add to dashboard Cite

n 1992, Brugada and Brugada described 8 cases of aborted sudden death in patients without demonstrable structural heart disease but with a characteristic electrocardiogram pattern (Bru-ECG) consisting of right bundle-branch block and ST-segment elevation in leads V1-3. 1 More prominent ST-segment elevation in the right precordial leads has been observed immediately before or after episodes of aborted sudden cardiac death in some patients, 2,3 but asymptomatic patients with Bru-ECG have been described. [4][5][6] Brugada et al also reported that the incidence of arrhythmic events is similar in symptomatic and asymptomatic patients with Bru-ECG. 7 These reports suggest that all patients with characteristic Bru-ECG are at risk for sudden cardiac death, but the variety of arrhythmic events associated with the Bru-ECG and the relationship between the occurrence of arrhythmic events and STsegment elevation is unknown. Therefore, we investigated the characteristics of arrhythmic events in patients with the Bru-ECG. Methods PatientsData on 30 patients (28 men; mean age, 51±14 years, 5 patients >65 years) with the Bru-ECG were recruited from September 1, 1998 until arrhythmic events. Eight patients were having a health examination, 7 were in hospital for diseases other than cardiac disease, and 15 were in the department of cardiology. Twenty-four had 'coved type' and 6 patients had 'saddle-back type' ST-segment elevation on initial presentation (Fig 1). Ten patients (33%) had family members with aborted sudden cardiac death (eg, case 5 is the father of case 7). Clinical data, including electrocardiographic findings, did not differ between those patients in whom aborted sudden cardiac death (SCD group) occurred and those in whom it did not (non-SCD group) ( Table 1). None of the patients suffered from chest pain during the appearance of the Bru-ECG. Patients with angina pectoris and acute myocardial infarction were excluded on the basis of laboratory findings, exercise tests or coronary angiography. Echocardiography findings, including cardiac function and cardiac chamber sizes, were normal in all patients. All 22 patients who underwent an exercise test above 6.8 METS had negative findings with decreased or unchanged STsegment elevation. All 14 patients who underwent coronary angiography had normal findings. Programmed electrical investigations were performed in 4 SCD patients and 4 from the non-SCD group. A maximum of 3 ventricular extrastimuli were delivered and 3 of the SCD patients had ventricular fibrillation. Flecainide (2 mg/kg per 10 min) or oral pilsicainide (100-150 mg/day) were administrated to 7 patients and the sodium channel blockers elevated the STsegment in all 7. The ST-segment changed markedly in 28 patients and 2 normalized during the follow-up period. ECG MeasurementAll ECG measurements were performed by a single experienced investigator who was unaware of the clinical information. The QT interval was measured from the beginning of the QRS complex to the end of the T wave and corrected for heart rate us...

show abstract

mentioning

confidence: 99%

Arrhythmias in Patients With Brugada-Type Electrocardiographic Findings

et al. 2001

View full text Add to dashboard Cite

show abstract

“…13 Induction of VF during the drug challenge test or after the administration of Na + -channel blockers in patients with paroxysmal atrial fibrillation with typical ST-segment elevation has been described. 3,14,15 However, we carefully administered pilsicainide with continuous ECG monitoring and immediately discontinued administration when marked ST-segment elevation, excessive QRS prolongation or ventricular arrhythmias were observed. We completed the drug challenge test safely without any severe adverse events.…”

Section: Na + -Channel-blocker Challenge Test Using Pilsicainidementioning

confidence: 99%

Different Effect of the Pure Na+ Channel-Blocker Pilsicainide on the ST-Segment Response in the Right Precordial Leads in Patients With Normal Left Ventricular Function

Ueyama

Shimizu

Yamagata

et al. 2007

Circ J

View full text Add to dashboard Cite

“…24, 25 In Japan, pilsicainide, which is a pure Na + -channel blocker and a class Ic drug in the Vaughan Williams classification, 26 is usually administrated intravenously at 0.1 mg · kg -1 · min -1 over 10 min (total, 1 mg/kg). Other class I anti-arrhythmic agents have ion-channel-blocking effects not only on the Na + channels but also on K + channels, including Ito, which results in a spike-and-dome morphology of the epicardial action potential.…”

Section: Na + -Channel-blocker Challenge Testmentioning

confidence: 99%

Is This a Philosophic Issue?

Shimizu

2010

Circ J

View full text Add to dashboard Cite

Brugada syndrome (BS) has an intermittent or concealed type, which can be unmasked by the sodium (Na + )-channel-blocker challenge test. The appropriate risk stratification of patients with a drug-induced Brugada-type electrocardiographic (ECG), especially those without a history of syncope or aborted sudden cardiac death, remains unclear. The prognosis of patients with BS depends on the clinical type, cardiac arrest, syncope or if asymptomatic. The ratio of the asymptomatic group varies from 56.9% to 63.6% and, furthermore, their annual cardiac event rate is relatively lower at 0.24-3.6% compared with the cardiac arrest group. Patients with a druginduced Brugada-type ECG have a poor prognosis if they had a history of ventricular fibrillation (VF) or aborted sudden cardiac death, because their risk becomes similar to that of patients with spontaneous Brugada-type ECG. They have the disturbance of the Na + -channel and the electrophysiologic substrate of VF, proven by the high inducibility of VF by stimulation test even in patients without spontaneous VF. Spontaneous VF will never occur if there is no VF substrate. Implantable cardioverter-defibrillators will certainly protect them, so patients with a drug-induced Brugada-type ECG, even without a history of VF or aborted sudden cardiac death, should be considered to have a poor prognosis. (Circ J 2010; 74: 2455 - 2463

show abstract

Unmasking Effect of Propafenone on the Concealed Form of the Brugada Phenomenon

Abstract: A case report of a patient with frequent ventricular premature beats but with an otherwise normal ECG and no structural heart disease. Propafenone in therapeutical doses unmasked the ECG picture of the Brugada phenomenon.

Cited by 55 publications

References 9 publications

Arrhythmias in Patients With Brugada-Type Electrocardiographic Findings

Arrhythmias in Patients With Brugada-Type Electrocardiographic Findings

Different Effect of the Pure Na+ Channel-Blocker Pilsicainide on the ST-Segment Response in the Right Precordial Leads in Patients With Normal Left Ventricular Function

Is This a Philosophic Issue?

Contact Info

Product

Resources

About