Key result
ICD remains first-line Brugada syndrome treatment with drugs and radiofrequency ablation as key adjuncts.
This review summarizes current treatments for Brugada syndrome, emphasizing ICDs as first-line therapy and highlighting the need for novel cardio-selective Ito blockers.
Supports ICD-first strategy in Brugada syndrome; leaves open efficacy of novel Ito blockers pending randomized trials.
Introduction: Brugada syndrome (BrS) is an inherited cardiac arrhythmia syndrome characterized by ST-segment elevation in right precordial ECG leads and associated with sudden cardiac death in young adults. The ECG manifestations of BrS are often concealed but can be unmasked by sodium channel blockers and fever.Areas covered: Implantation of a cardioverter defibrillator (ICD) is first-line therapy for BrS patients presenting with prior cardiac arrest or documented VT. A pharmacological approach to therapy is recommended in cases of electrical storm, as an adjunct to ICD and as preventative therapy. The goal of pharmacological therapy is to produce an inward shift to counter the genetically-induced outward shift of ion channel current flowing during the early phases of the ventricular epicardial action potential. This is accomplished by augmentation of ICa using □□adrenergic agents or phosphodiesterase III inhibitors or via inhibition of Ito. Radiofrequency ablation of the right ventricular outward flow tract epicardium is effective in suppressing arrhythmogenesis in BrS patients experiencing frequent appropriate ICD-shocks.Expert commentary: Understanding of the pathophysiology and approach to therapy of BrS has advanced considerably in recent years, but there remains an urgent need for development of cardio-selective and ion-channel-specific Ito blockers for treatment of BrS.
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Argenziano et al. (2018) conducted a review in Brugada syndrome. ICD, pharmacological therapy, and radiofrequency ablation was evaluated. Recent advances in Brugada syndrome therapy highlight ICD as first-line treatment, with pharmacological approaches and radiofrequency ablation serving as important adjuncts.
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