Role of pharmacotherapy in Brugada syndrome
Tsuchiya, Takeshi (2004) Role of pharmacotherapy in Brugada syndrome. Indian Pacing and Electrophysiology Journal, 4 (1). pp. 26-32. ISSN 0972-6292
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Brugada syndrome is a unique form of idiopathic ventricular fibrillation (VF), and is characterized by an ECG pattern with right bundle branch block (J wave), ST-segment elevation and terminal T-wave inversion in leads V1 through V3 1,2,3,4,5,6,7,8,9,10. It accounts for approximately 20% of all cases of sudden cardiac death in patients with structurally normal hearts and appears to be more frequent in Southeast Asia than in other regions5. To date, the only established therapy for preventing sudden cardiac death due to VF in this disease is an implantation of an implantable cardioverter defibrillator (ICD)1,2,3,4. Although there is no room for discussion regarding the excellent and uniform efficacy of ICDs for terminating VF, the effect is confined to the termination of VF, and ICDs cannot contribute to the prevention of VF. Therefore, there are some concerns regarding ICD therapy. The first is electrical storm associated with VF or polymorphic ventricular tachycardia, which is defined as frequent appropriate ICD shock deliveries for ventricular tachyarrhythmias of >3 times over 24 hours. Chalvidan et al. 10, reported a patient who suffered from incessant VF episodes (electrical storm) and became near-fatal, but subsequently fully recovered. The second is ICD related complications including lead dislodgment, inappropriate shock delivery, infection requiring ICD removal and so on 11,12,13. The third is the indication of ICDs for infant cases of Brugada syndrome, in which the size of the ICD is too large for implantation 11,12,13. A new therapy other than ICD implantation to overcome these concerns seems to be urgent.
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