Key result
Catheter ablation successfully eliminates inducible AVNRT in drug-induced Brugada syndrome without inducible ventricular arrhythmias.
Why the study?
There is no definite consensus regarding the management of asymptomatic patients with Brugada syndrome, particularly the role of programmed stimulation for risk stratification.
Does complete EPS identify inducible arrhythmias in patients with drug-induced Brugada syndrome and palpitations?
Case Report (n=1)
Does complete EPS identify inducible arrhythmias in patients with drug-induced Brugada syndrome and palpitations?
Complete EPS may be beneficial for identifying and treating concomitant supraventricular arrhythmias in patients with drug-induced Brugada syndrome and palpitations.
May identify treatable AVNRT in drug-induced Brugada syndrome with palpitations; hypothesis-generating, requires prospective validation.
BACKGROUND: Brugada syndrome (BrS) is an inherited channelopathy, which is associated with sudden cardiac death due to rapid polymorphic VT or VF. There is no definite consensus regarding the management of asymptomatic patients. Some experts advocate close follow-up; others propose the programmed stimulation for risk stratification. We aimed to evaluate the benefit of complete atrial and ventricular stimulation in patients with BrS and palpitation. CASE PRESENTATION: A 30-year-old man was admitted to our hospital because of a family history of sudden cardiac death (SCD) at age less than 45 years. He complained of self-terminated episodes of palpitation with no history of syncope. Baseline ECG showed incomplete right bundle branch block (RBBB) and saddle-back-like ST deviation in V1. Flecainide challenge test (FCT) revealed Brugada pattern. Complete EPS was done for evaluation of VT/VF inducibility and probable concomitant supraventricular arrhythmias.Programmed atrial stimulation showed inducible typical slow-fast AVNRT with AH jump 75 msec. Successful slow pathway ablation was done. There was no inducible ventricular arrhythmia. CONCLUSIONS: Patients with drug-induced BrS, positive family history of SCD and also episodes of palpitation, benefit from complete EPS. However, ICD implementation is not recommended in asymptomatic patients with drug-induced BrS and negative EPS for ventricular stimulation.
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Hosseini et al. (2018) conducted a case report in Brugada syndrome (n=1). Complete electrophysiologic study (EPS) was evaluated on VT/VF inducibility and probable concomitant supraventricular arrhythmias. Complete electrophysiologic study in a patient with drug-induced Brugada syndrome identified inducible AVNRT with an AH jump of 75 msec, which was successfully ablated without inducible VT/VF.
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