Should all individuals with non diagnostic Brugada-like ECG abnormalities undergo sodium channel blocker challenge? A. Zorzi, F.Migliore, A, Marinelli, E.Marras*, A. Baritussio, G. Allocca*, L Leoni, G. Buja, S. Iliceto, P. Delise*, D. Corrado Inherited Arrhythmogenic Cardiomyopathy Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova * Division of Cardiology, Civil Hospital, Conegliano, Italy
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Should all individuals with non diagnostic Brugada-like ECG
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Should all individuals with non
diagnostic Brugada-like ECG
abnormalities undergo sodium
channel blocker challenge?
A. Zorzi, F.Migliore, A, Marinelli, E.Marras*, A. Baritussio, G.
Allocca*, L Leoni, G. Buja, S. Iliceto, P. Delise*, D. Corrado
Inherited Arrhythmogenic Cardiomyopathy Unit,
Department of Cardiac, Thoracic and Vascular Sciences, University of Padova
* Division of Cardiology, Civil Hospital, Conegliano, Italy
• Arrhythmogenic disease
• ECG pattern of ST-segment elevation in right precordial leads
• Increased risk of sudden death due to VF
• Structurally normal heart
• SCN5A mutation in 18-30% of cases
BACKGROUND (1)
Brugada Syndrome
Brugada P. Brugada Syndrome: Up-date 2009. Hellenic J Cardiol 2009;50:352-72
ECG repolarization pattern
BACKGROUND (2)
BACKGROUND (3)
Sodium channel blocker challenge (SCB)
In familiar BrS with a positive SCN5A gene mutation: test sensitivity ~ 70-80%
test specificity ~ 90%
In the general population: test accurancy unknow
May a positive test reflect an individual non pathologic response to the Na+ channel blockers ?
BACKGROUND (4)
Risk stratification
Priori et al. Circulation. 2002;105:1342-1347 Eckardt et al. Circulation. 2005;111:257-263
OBJECTIVE
The aim of this study was to assess whether
systematic SCB test of individuals with non
diagnostic Brugada type 2/3 ECG test impacts
clinical management and outcome.
METHODS (1)
Study population
153 consecutive subjects referred to 2 institutions of the Veneto Region of Italy;
Enrollment criteria
Demostration of non diagnostic Brugada ECG, either type 2 or 3;
No previous spontaneous diagnostic Brugada ECG type 1;
No structural heart disease and others conditions mimicking Brugada Syndrome
METHODS (2)
Source of non diagnostic Brugada ECG abnormalities:
Routine ECG screening in 64 (42%).
Study of asymptomatic family members of patients with BrS or SD in 48 (31%);
Investigation of syncope of unknown origin in 36 (24%) patients;
Investigation of sudden cardiac arrest in 5 (3%);
METHODS (3) SCB test : All subjects underwent a SCB test (flecainide 2mg/Kg iv in 10 min
or ajmaline 1 mg/Kg iv in 5 min).The test was considered positive if a type 1 ECG
was induced;
Electrophysiological study (EPS): 2 different pacing cycle lenghts (600, 400
msc) with up to 3 extra stimuli ( two ventricular sites, RV apex and RVOT);
ICD implantation: proposed to all the patients with a positive SCB test and
previous sudden cardiac arrest, syncope or a postitive EPS