Brugada syndrome - Revision history

Blsimpso: /* Background */

2021-09-03T01:09:18Z

Background

← Older revision		Revision as of 01:09, 3 September 2021
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	==Background==		==Background==
			*Brugada syndrome is a rare, inherited arrhythmic disorder causing an increased risk of syncope and sudden death due to ventricular fibrillation.
	*Consider as cause of syncope in patients with family history of sudden death		*Consider as cause of syncope in patients with family history of sudden death
	*80% of Brugada syndrome diagnosed only after a cardiac arrest<ref>Paul M., Gerss J., Schulze-Bahr E.; Role of programmed ventricular stimulation in patients with Brugada syndrome: a meta-analysis of worldwide published data. Eur Heart J. 28 2007:2126-2133.</ref>		*80% of Brugada syndrome diagnosed only after a cardiac arrest<ref>Paul M., Gerss J., Schulze-Bahr E.; Role of programmed ventricular stimulation in patients with Brugada syndrome: a meta-analysis of worldwide published data. Eur Heart J. 28 2007:2126-2133.</ref>

Blsimpso: /* External Links */

2021-07-01T02:46:10Z

External Links

← Older revision		Revision as of 02:46, 1 July 2021
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	==External Links==		==External Links==
	*[https://www.youtube.com/watch?v=NJL8An6uO1Y Amal Mattu ECG Case: March 4 2012]		*[https://www.youtube.com/watch?v=NJL8An6uO1Y Amal Mattu ECG Case: March 4 2012]
			*[http://www.emdocs.net/ecg-pointers-syncope-and-brugada-syndrome/ emDocs - ECG Pointers: Syncope and Brugada Syndrome]

	==See Also==		==See Also==

Elcatracho: /* ECG Unmasking FactorsIkeda T., Abe A., Yusu S.; The full stomach test as a novel diagnostic technique for identifying patients at risk of Brugada syndrome. J Cardiovasc Electrophysiol. 17 2006:602-607.Shimeno K., Takagi M., Maeda K., Tatsumi...

2021-01-01T18:02:10Z

/* ECG Unmasking FactorsIkeda T., Abe A., Yusu S.; The full stomach test as a novel diagnostic technique for identifying patients at risk of Brugada syndrome. J Cardiovasc Electrophysiol. 17 2006:602-607.Shimeno K., Takagi M., Maeda K., Tatsumi...

← Older revision		Revision as of 18:02, 1 January 2021
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	''v1-v2 lead placement in 2nd or 3rd IC spaces (rather than conventional 4th IC space) increases chance of recording type I pattern<ref>Shimizu W., Matsuo K., Takagi M.; Body surface distribution and response to drugs of ST segment elevation in Brugada syndrome: clinical implication of eighty-seven-lead body surface potential mapping and its application to twelve-lead electrocardiograms. J Cardiovasc Electrophysiol. 11 2000:396-404.</ref>''		''v1-v2 lead placement in 2nd or 3rd IC spaces (rather than conventional 4th IC space) increases chance of recording type I pattern<ref>Shimizu W., Matsuo K., Takagi M.; Body surface distribution and response to drugs of ST segment elevation in Brugada syndrome: clinical implication of eighty-seven-lead body surface potential mapping and its application to twelve-lead electrocardiograms. J Cardiovasc Electrophysiol. 11 2000:396-404.</ref>''

	====ECG Unmasking Factors<ref>Ikeda T., Abe A., Yusu S.; The full stomach test as a novel diagnostic technique for identifying patients at risk of Brugada syndrome. J Cardiovasc Electrophysiol. 17 2006:602-607.</ref><ref>Shimeno K., Takagi M., Maeda K., Tatsumi H., Doi A., Yoshiyama M.; Usefulness of multichannel Holter ECG recording in the third intercostal space for detecting type 1 Brugada ECG: comparison with repeated 12-lead ECGs. J Cardiovasc Electrophysiol. 20 2009:1026-1031.</ref><ref>Keller D.I., Huang H., Zhao J.; A novel SCN5A mutation, F1344S, identified in a patient with Brugada syndrome and fever-induced ventricular fibrillation. Cardiovasc Res. 70 2006:521-529.</ref>====		====ECG Unmasking Factors<ref>Ikeda T., Abe A., Yusu S.; The full stomach test as a novel diagnostic technique for identifying patients at risk of Brugada syndrome. J Cardiovasc Electrophysiol. 17 2006:602-607.</ref><ref>Shimeno K., Takagi M., Maeda K., Tatsumi H., Doi A., Yoshiyama M.; Usefulness of multichannel Holter ECG recording in the third intercostal space for detecting type 1 Brugada ECG: comparison with repeated 12-lead ECGs. J Cardiovasc Electrophysiol. 20 2009:1026-1031.</ref><ref>Keller D.I., Huang H., Zhao J.; A novel SCN5A mutation, F1344S, identified in a patient with Brugada syndrome and fever-induced ventricular fibrillation. Cardiovasc Res. 70 2006:521-529.</ref><ref>ANTZELEVITCH, C., & BRUGADA, R. (2002). Fever and Brugada Syndrome. Pacing and Clinical Electrophysiology, 25(11), 1537–1539. doi:10.1046/j.1460-9592.2002.01537.x</ref>====
	*Type 1 ECG findings can be transient and "unmasked" by the following:		*Type 1 ECG findings can be transient and "unmasked" by the following:
	**[[Fever]]		**[[Fever]]

Elcatracho: /* Clinical Features */

2021-01-01T18:01:30Z

Clinical Features

← Older revision		Revision as of 18:01, 1 January 2021
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	*Patients may have [[Vfib]] [[cardiac arrest]] or sudden death		*Patients may have [[Vfib]] [[cardiac arrest]] or sudden death
	*Diagnostic [[ECG]] findings transient and variable, with only 1/3 of serial ECGs diagnostic in confirmed spontaneous coved-type Brugada syndrome patients<ref>Richter S., Sarkozy A., Veltmann C.; Variability of the diagnostic ECG pattern in an ICD patient population with Brugada syndrome. J Cardiovasc Electrophysiol. 20 2009:69-75.</ref>		*Diagnostic [[ECG]] findings transient and variable, with only 1/3 of serial ECGs diagnostic in confirmed spontaneous coved-type Brugada syndrome patients<ref>Richter S., Sarkozy A., Veltmann C.; Variability of the diagnostic ECG pattern in an ICD patient population with Brugada syndrome. J Cardiovasc Electrophysiol. 20 2009:69-75.</ref>
	**Fever can unmask Brugada sign and increase risk of SCD<ref>ANTZELEVITCH, C., & BRUGADA, R. (2002). Fever and Brugada Syndrome. Pacing and Clinical Electrophysiology, 25(11), 1537–1539. doi:10.1046/j.1460-9592.2002.01537.x</ref>

	==Differential Diagnosis==		==Differential Diagnosis==

Elcatracho: /* Clinical Features */

2021-01-01T18:00:05Z

Clinical Features

← Older revision		Revision as of 18:00, 1 January 2021
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	*Patients may have [[Vfib]] [[cardiac arrest]] or sudden death		*Patients may have [[Vfib]] [[cardiac arrest]] or sudden death
	*Diagnostic [[ECG]] findings transient and variable, with only 1/3 of serial ECGs diagnostic in confirmed spontaneous coved-type Brugada syndrome patients<ref>Richter S., Sarkozy A., Veltmann C.; Variability of the diagnostic ECG pattern in an ICD patient population with Brugada syndrome. J Cardiovasc Electrophysiol. 20 2009:69-75.</ref>		*Diagnostic [[ECG]] findings transient and variable, with only 1/3 of serial ECGs diagnostic in confirmed spontaneous coved-type Brugada syndrome patients<ref>Richter S., Sarkozy A., Veltmann C.; Variability of the diagnostic ECG pattern in an ICD patient population with Brugada syndrome. J Cardiovasc Electrophysiol. 20 2009:69-75.</ref>
			**Fever can unmask Brugada sign and increase risk of SCD<ref>ANTZELEVITCH, C., & BRUGADA, R. (2002). Fever and Brugada Syndrome. Pacing and Clinical Electrophysiology, 25(11), 1537–1539. doi:10.1046/j.1460-9592.2002.01537.x</ref>

	==Differential Diagnosis==		==Differential Diagnosis==

Cdichang: /* Drugs to be Avoided */

2020-05-12T21:20:49Z

Drugs to be Avoided

← Older revision		Revision as of 21:20, 12 May 2020
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	**[[Ketamine]]		**[[Ketamine]]
	**[[Tramadol]]		**[[Tramadol]]
			**[[Lithium]]
			**Except for quinidine, class I antiarrhythmic drugs, particularly sodium channel blockers such as procainamide and flecainide should be avoided
	**Certain [[antiepileptics\|antiepileptic]] medications		**Certain [[antiepileptics\|antiepileptic]] medications
	**Certain [[tricyclic antidepressants]]		**Certain [[tricyclic antidepressants]]

Rossdonaldson1: /* Unmasking FactorsIkeda T., Abe A., Yusu S.; The full stomach test as a novel diagnostic technique for identifying patients at risk of Brugada syndrome. J Cardiovasc Electrophysiol. 17 2006:602-607.Shimeno K., Takagi M., Maeda K., Tatsumi H.,...

2019-12-29T20:12:58Z

/* Unmasking FactorsIkeda T., Abe A., Yusu S.; The full stomach test as a novel diagnostic technique for identifying patients at risk of Brugada syndrome. J Cardiovasc Electrophysiol. 17 2006:602-607.Shimeno K., Takagi M., Maeda K., Tatsumi H.,...

← Older revision		Revision as of 20:12, 29 December 2019
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	''v1-v2 lead placement in 2nd or 3rd IC spaces (rather than conventional 4th IC space) increases chance of recording type I pattern<ref>Shimizu W., Matsuo K., Takagi M.; Body surface distribution and response to drugs of ST segment elevation in Brugada syndrome: clinical implication of eighty-seven-lead body surface potential mapping and its application to twelve-lead electrocardiograms. J Cardiovasc Electrophysiol. 11 2000:396-404.</ref>''		''v1-v2 lead placement in 2nd or 3rd IC spaces (rather than conventional 4th IC space) increases chance of recording type I pattern<ref>Shimizu W., Matsuo K., Takagi M.; Body surface distribution and response to drugs of ST segment elevation in Brugada syndrome: clinical implication of eighty-seven-lead body surface potential mapping and its application to twelve-lead electrocardiograms. J Cardiovasc Electrophysiol. 11 2000:396-404.</ref>''

	===Unmasking Factors<ref>Ikeda T., Abe A., Yusu S.; The full stomach test as a novel diagnostic technique for identifying patients at risk of Brugada syndrome. J Cardiovasc Electrophysiol. 17 2006:602-607.</ref><ref>Shimeno K., Takagi M., Maeda K., Tatsumi H., Doi A., Yoshiyama M.; Usefulness of multichannel Holter ECG recording in the third intercostal space for detecting type 1 Brugada ECG: comparison with repeated 12-lead ECGs. J Cardiovasc Electrophysiol. 20 2009:1026-1031.</ref><ref>Keller D.I., Huang H., Zhao J.; A novel SCN5A mutation, F1344S, identified in a patient with Brugada syndrome and fever-induced ventricular fibrillation. Cardiovasc Res. 70 2006:521-529.</ref>===		====ECG Unmasking Factors<ref>Ikeda T., Abe A., Yusu S.; The full stomach test as a novel diagnostic technique for identifying patients at risk of Brugada syndrome. J Cardiovasc Electrophysiol. 17 2006:602-607.</ref><ref>Shimeno K., Takagi M., Maeda K., Tatsumi H., Doi A., Yoshiyama M.; Usefulness of multichannel Holter ECG recording in the third intercostal space for detecting type 1 Brugada ECG: comparison with repeated 12-lead ECGs. J Cardiovasc Electrophysiol. 20 2009:1026-1031.</ref><ref>Keller D.I., Huang H., Zhao J.; A novel SCN5A mutation, F1344S, identified in a patient with Brugada syndrome and fever-induced ventricular fibrillation. Cardiovasc Res. 70 2006:521-529.</ref>====
	*Type 1 ECG findings can be transient and "unmasked" by the following:		*Type 1 ECG findings can be transient and "unmasked" by the following:
	**[[Fever]]		**[[Fever]]

Rossdonaldson1: /* Disposition */

2019-12-29T20:12:05Z

Disposition

← Older revision		Revision as of 20:12, 29 December 2019
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	*Active tachydysrhythmia --> admission<ref>M Sharon, et al. ECG of the Month. Annals of Emergency Medicine. December 2019. 74(6);782-785</ref>		*Active tachydysrhythmia --> admission<ref>M Sharon, et al. ECG of the Month. Annals of Emergency Medicine. December 2019. 74(6);782-785</ref>

	===Inpatient vs ~~outpatient~~ ICD ~~placement~~===		===Inpatient vs Outpatient ICD Placement===
	*Prophylactic ICDs may have risks of complications greater than benefits conferred<ref>Sacher F., Probst V., Iesaka Y.; Outcome after implantation of a cardioverter-defibrillator in patients with Brugada syndrome: a multicenter study. Circulation. 114 2006:2317-2324.</ref><ref>Rosso R., Glick A., Glikson M.; Outcome after implantation of cardioverter defibrillator in patients with Brugada syndrome: a multicenter Israeli study (ISRABRU). Isr Med Assoc J. 10 2008:435-439.</ref>		*Prophylactic ICDs may have risks of complications greater than benefits conferred<ref>Sacher F., Probst V., Iesaka Y.; Outcome after implantation of a cardioverter-defibrillator in patients with Brugada syndrome: a multicenter study. Circulation. 114 2006:2317-2324.</ref><ref>Rosso R., Glick A., Glikson M.; Outcome after implantation of cardioverter defibrillator in patients with Brugada syndrome: a multicenter Israeli study (ISRABRU). Isr Med Assoc J. 10 2008:435-439.</ref>

Rossdonaldson1: /* Disposition */

2019-12-29T20:11:48Z

Disposition

← Older revision		Revision as of 20:11, 29 December 2019
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	==Disposition==		==Disposition==
	**Incidental finding with no suggestive family or patient history --> education and general cardiology referral<ref>M Sharon, et al. ECG of the Month. Annals of Emergency Medicine. December 2019. 74(6);782-785</ref>		*Incidental finding with no suggestive family or patient history (e.g. syncope, tachydysrhythmia, sudden cardiac death)--> education and general cardiology referral<ref>M Sharon, et al. ECG of the Month. Annals of Emergency Medicine. December 2019. 74(6);782-785</ref>
			*Suggestive family or patient history --> disposition in consultation with cardiology<ref>M Sharon, et al. ECG of the Month. Annals of Emergency Medicine. December 2019. 74(6);782-785</ref>
			*Active tachydysrhythmia --> admission<ref>M Sharon, et al. ECG of the Month. Annals of Emergency Medicine. December 2019. 74(6);782-785</ref>

	===Inpatient vs outpatient ICD placement===		===Inpatient vs outpatient ICD placement===

Rossdonaldson1: /* Active Tachydysrhythmia */

2019-12-29T20:09:02Z

Active Tachydysrhythmia

← Older revision		Revision as of 20:09, 29 December 2019
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	===Active Tachydysrhythmia===		===Active Tachydysrhythmia===
	*Antidysrhythmics trials have inconsistently shown clinical benefit, but potential VF-terminating and prevention meds may include [[quinidine]], [[isoproterenol]]<ref>Postema PG, Wolpert C, Amin AS, Probst V, Borggrefe M, Roden DM, et al. Drugs and Brugada syndrome patients: review of the literature, recommendations, and an up-to-date website (www.brugadadrugs.org). Heart Rhythm. 2009 Sep. 6(9):1335-41.</ref>		*Antidysrhythmics trials have inconsistently shown clinical benefit, but potential VF-terminating and prevention meds may include [[quinidine]], [[isoproterenol]]<ref>Postema PG, Wolpert C, Amin AS, Probst V, Borggrefe M, Roden DM, et al. Drugs and Brugada syndrome patients: review of the literature, recommendations, and an up-to-date website (www.brugadadrugs.org). Heart Rhythm. 2009 Sep. 6(9):1335-41.</ref>
	*See [[~~Electrical~~ storm]] for 3 or more episodes of sustained [[ventricular tachycardia]], [[ventricular fibrilation]], or ICD shocks within 24 hours		*See [[electrical storm]] for 3 or more episodes of sustained [[ventricular tachycardia]], [[ventricular fibrilation]], or ICD shocks within 24 hours

	===Drugs to be Avoided===		===Drugs to be Avoided===