Key result
Pilsicainide challenge unmasks Brugada syndrome after cardiac arrest during emergence from general anesthesia.
Case Report (n=1)
No
Brugada syndrome should be considered in the differential diagnosis of unexpected ventricular tachycardia and cardiac arrest during general anesthesia, and can be unmasked by a sodium channel blocker challenge.
Brugada syndrome merits consideration in unexplained perioperative arrest; hypothesis-generating for sodium channel blocker testing protocols.
54歳，男性．入院時の心電図では異常を認めず，転落による骨折に対して全身麻酔下で手術が施行された．しかし麻酔覚醒時にST低下が先行する多形性心室頻拍が出現し，その後心停止に至った．心肺蘇生を行い自己心拍が再開し救命し得た．術後の精査でピルシカイニド負荷試験を施行したところ心電図でCoved型ST上昇を認めBrugada症候群と診断された．Brugada症候群は心筋Naチャネル遺伝子の変異が発症原因の一つとされており，その診断にピルシカイニドをはじめとしたNaチャネル遮断薬による負荷試験が有用である．予期せぬ心室頻拍の鑑別診断の一つとしてBrugada症候群を考える必要がある．
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OSHIRO et al. (2024) conducted a case report in Brugada syndrome (n=1). Pilsicainide challenge test was evaluated on Coved-type ST-segment elevation on electrocardiogram. A 54-year-old male who experienced cardiac arrest during emergence from general anesthesia was successfully resuscitated and subsequently diagnosed with Brugada syndrome via a pilsicainide challenge test.
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