Brugada Patient and the Environment: Harmful Factors and Drugs Juhani Junttila, MD Insitute of Clinical Medicine, University of Oulu, Oulu, Finland
Mar 26, 2015
Brugada Patient and the Environment:Harmful Factors and Drugs
Juhani Junttila, MDInsitute of Clinical Medicine, University of Oulu, Oulu, Finland
Case
• 50 yrs male• Paroxysmal Afib• Treated with
flecainide• No family history of
SCD• No syncopal
episodes
Case
• Flecainide discontinued
• RBBB underlying morphology??
Induced Brugada ECG
• Patients with induced Brugada ECG by medication of by fever are at imminent risk for ventricular arrhythmias– In a case series of 47 patients with induced
Brugada ECG 51% developed ventricular arrhythmias
• Most cases had ventricular arrhythmias during fever or during anesthesia
Junttila MJ et al. Circulation 2008
Ion channel effects
IKr
IKs
Ito
INa
ICa
INa
Ito
Current decay for WT (squares) and Thr1620Met (circles) at 22°C (▪, •) and 32°C (□, ○).
Dumaine R et al. Circulation Research 1999;85:803-809
Fever
Fever
• 402 patients with fever (>38°) and 909 without
• 2% (n= 8) type I Brugada ECG in fever patients– 0.1% in controls, p< 0.001– Four had diagnostic finging of the syndrome after
fever• One Brugada ECG in repeated ECG• Three with positive ajmaline test
• All patients with Brugada ECG were asymptomatic and remained asymptomatic during 30mo of follow up
Adler A et al. Heart Rhythm. 2013
Fever
Sauna and Hot Tub
• Sauna: 30min in 80C° core temperature increase ~1C° in adults and ~2C° in children– Leppäluoto J. Ann Clin Res. 1988;20(4):240-3
• Hot tub: 15min of 40C° increased core body temperature by ~0.6C° – Allison TG, Miller TD, Squires RW et al. Mayo Clin Proc. 1993 Jan;68(1):19-25.
Sports
• Strenuous indurance training might be harmful – Increase in vagal tone?
• Leisure-time sport activity might not
be harmful• Patients with ICD should be
restricted from competetive sports?– Sports with low cardiovascular demand
should be allowedHeidbüchel H et al. Study Group on Sports Cardiology of the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil. 2006
Other factors
• HypokalemiaAraki T et al. Circ J. 2003
• Glucose-insulin infusionNogami A et al. Pacing Clin Electrophysiol.
2003
Drugs –avoided
www.brugadadrugs.org Postema et al. Heart Rhythm 2009 and Postema et al. Europace 2013
Drugs –preferably avoided
www.brugadadrugs.org Postema et al. Heart Rhythm 2009 and Postema et al. Europace 2013
Drugs
Propofol infusion syndrome• Well known among anesthesiologists• Brugada ECG among first warning
signs • Lactic acidosis results in organ
failure
Conclusion
Antzelevitch C et al. Circulation 2005;111:659-670