Programmed Ventricular Stimulation in Brugada Syndrome: An Irrefusable Offer or an Inaccurate Tool for Patients with Absent or Doubtful Symptoms?

Antonis S Manolis, Sokratis Avlonitis

Abstract


A case of a patient with Brugada pattern on ECG is presented with dubious symptoms whose management was guided by an electrophysiology (EP) study where programmed ventricular stimulation easily induced ventricular fibrillation with only two ventricular extrastimuli and facilitated a decision to implant a defibrillator for sudden death protection. Images of the EP tracings are provided that illustrate the findings and the pros and cons of such an approach are herein discussed. Rhythmos 2019;14(3):55-57.


Keywords


Brugada syndrome; sudden cardiac death; ventricular fibrillation; electrophysiology study; programmed ventricular stimulation; implantable cardioverter defibrillator

Full Text:

PDF

References


Priori SG, Blomstrom-Lundqvist C, Mazzanti A, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J 2015;36:2793-867.

Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2018;72:e91-e220.

Priori SG, Gasparini M, Napolitano C, et al. Risk stratification in Brugada syndrome: results of the PRELUDE (PRogrammed ELectrical stimUlation preDictive valuE) registry. J Am Coll Cardiol 2012;59:37-45.

Brugada P, Brugada R, Mont L, et al. Natural history of Brugada syndrome: the prognostic value of programmed electrical stimulation of the heart. J Cardiovasc Electrophysiol 2003;14:455-7.

Sieira J, Conte G, Ciconte G, et al. Prognostic value of programmed electrical stimulation in Brugada syndrome: 20 years experience. Circ Arrhythm Electrophysiol 2015;8:777-84.

Makimoto H, Kamakura S, Aihara N, et al. Clinical impact of the number of extrastimuli in programmed electrical stimulation in patients with Brugada type 1 electrocardiogram. Heart Rhythm 2012;9:242-8.

Probst V, Veltmann C, Eckardt L, et al. Long-term prognosis of patients diagnosed with Brugada syndrome: Results from the FINGER Brugada Syndrome Registry. Circulation 2010;121:635-43.

Sroubek J, Probst V, Mazzanti A, et al. Programmed Ventricular Stimulation for Risk Stratification in the Brugada Syndrome: A Pooled Analysis. Circulation 2016;133:622-30.

Kusumoto FM, Bailey KR, Chaouki AS, et al. Systematic Review for the 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2018;72:1653-76.

Li X, Sacher F, Kusano KF, et al. Pooled Analysis of Risk Stratification of Spontaneous Type 1 Brugada ECG: Focus on the Influence of Gender and EPS. Front Physiol 2018;9:1951.


Refbacks

  • There are currently no refbacks.