Brugada syndrome (BrS) is a rare inherited cardiac condition associated with a heightened risk of malignant arrhythmias, particularly during exposure to various pharmacological agents, including certain local anesthetics with sodium channel-blocking properties. This condition often generates significant concern among dental professionals, as the routine use of local anesthetics raises uncertainty about safety protocols and perceived medico-legal risks, frequently leading to patient refusal. The result is a silent yet systematic exclusion of these patients from standard pathways of care, with implications that extend beyond the clinical domain to encompass ethical, deontological, and social dimensions. We report the case of a 29-year-old male with BrS and a subcutaneous implantable cardioverter-defibrillator who underwent a conservative restorative dental procedure in a private outpatient clinic. Given the potential risk of arrhythmia during anesthetic infiltration, 4% articaine with epinephrine 1:100,000 was administered slowly and at the minimum effective dose under continuous cardiologic supervision, with real-time ECG and vital sign monitoring initiated prior to injection and maintained throughout the session. The treatment was completed uneventfully, with no ECG abnormalities observed. While limited to a single observation, this case illustrates that, under carefully controlled conditions and with appropriate precautions, outpatient dental management of patients with BrS may be considered a viable option in selected cases. This report includes a brief review of the literature and a focused discussion on the medico-legal implications to contextualize this case and support safe, ethical, and reproducible clinical decision-making in similar outpatient settings.
Valente et al. (Tue,) studied this question.