Key result
Isoproterenol then quinidine suppresses refractory ventricular fibrillation storm in Brugada syndrome.
Why the study?
The implantable cardiac defibrillator is the only effective treatment for VF in Brugada Syndrome, but drug therapies like quinidine and isoproterenol may provide additional benefits in acute and long-term management.
Case Report (n=1)
May be considered in refractory Brugada VF; leaves open need for prospective trials before broader adoption.
The use of an implantable cardiac defibrillator has been advocated as the only effective treatment for the management of ventricular fibrillation (VF) in patients with Brugada Syndrome (BrS). However, this device is only useful for terminating VF. Intermittent and/or recalcitrant VF for which lifesaving cardioversion occurs is a problematic situation in this patient population. The immediate use of appropriate antiarrhythmics in the acute setting has proven to be lifesaving. Quinidine has been well established as an effective antiarrhythmic in BrS, while isoproterenol (ISP) has had some recognition as well. The addition of drug therapy to prevent the induction of these arrhythmias has been shown to reduce the morbidity and mortality associated with BrS. It was proven to be especially effective in the presence of early repolarization, evidenced by the reduction or normalization of the early repolarization pattern on ECG. Thus, for the prophylactic management and long term suppression of VF in BrS, further prospective studies should be performed to determine the effectiveness of quinidine and ISP in this patient population.
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Dakkak et al. (2015) conducted a case report in Brugada Syndrome with ventricular fibrillation (n=1). Isoproterenol and Quinidine was evaluated on Arrhythmia recurrence. Isoproterenol infusion followed by oral quinidine successfully suppressed refractory ventricular fibrillation in a 25-year-old male with Brugada syndrome, who remained arrhythmia-free over a 7-month follow-up.
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