Why the study?
Does exercise stress testing in a patient on flecainide provoke a type 1 Brugada electrocardiogram pattern?
Does exercise stress testing in a patient on flecainide provoke a type 1 Brugada electrocardiogram pattern?
Exercise stress testing can exploit the use-dependent properties of flecainide to provoke a diagnostic type 1 Brugada pattern at higher heart rates.
Flecainide may induce Brugada pattern on exercise testing in early repolarization; this case leaves open need for prospective risk assessment without SCN5A variants.
A young man with baseline early repolarization was initiated on flecainide and diltiazem for symptomatic atrial arrhythmias. A treadmill stress test induced a type 1 Brugada electrocardiogram pattern at higher heart rates. Flecainide was discontinued. Genetic testing revealed no SCN5A mutations, and a 3-generation pedigree revealed no events of concern. In this case report, we review the use-dependent properties of flecainide. We also discuss how this property can be exploited during exercise stress testing to provoke the diagnostic type 1 Brugada pattern at higher heart rates.
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Safabakhsh et al. (2021) studied this question.
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