[SCD-FORUM] 6E RE: Brugada综合症 Dr. Ramon Brugada

[SCD Symposium]

6E RE: Brugada综合症   Dr. Ramon Brugada



亲爱的Arenzo教授：

在心电图为Ⅰ型的患者中没有必要进行阿义马林试 
验，这类患者的诊断是成立的。如果心电图呈“Ⅱ型 
或Ⅲ型”（不能诊断），阿义马林试验是推荐的。

在处理心电图Ⅰ型没有症状的患者过程中，你会发现 
很多方法。

①    继续随访直至他出现症状。

②    植入ICD，特别是家族中有心脏猝死的患者。

③    EPS可以作为危险分层的方法。阳性的非攻击性的 
EPS常预示患者有心率失常发生增加的危险。散发患者 
中阴性的EPS提示较好的预后。

正如你所知，EPS的应用是对没有症状的患者进行危险 
分层是有很大争议的。然而，前两种方法并不完善。 
患者的首发症状可能就是猝死，而ICD不能处理并发的 
问题，而且对于一个40岁没有症状的患者来说这不是 
一个很容易做出的决定。



谢谢。



Ramon Brugada MD FACC
Associate Professor of Medicine
Canadian Research Chair Genetics of Arrhythmias
University of Montreal
Director Clinical Cardiovascular Genetics Center
Montreal Heart Institute
5000 Rue Belanger
Montreal, QC H1T 1C8
Canada
ramon在brugada.org




Dear Dr Arenzo:
  In the individual with type I ecg, there is no need for an ajamline  
test, the diagnosis is made. If the ecg is "type II or III" (non- 
diagnostic), ajmaline test is recommended.

  You will find all the options available in how to deal with the  
asymptomatic patient with type I ecg.
  -          follow-up until he develops symptoms.
  -          ICD implantation, especially if there is a remote  
possibility of sudden cardiac death in the family
  -          EPS as tool for risk stratification. A positive non- 
aggressive EPS is very indicative of a patient with an increased risk  
for arrhythmogenecity. A negative EPS in the sporadic individual is  
indicative of good prognosis.


  As you well know, the use of EPS to risk stratify asymptomatic  
patients is very controversial. However, the first two options are  
not perfect. The first symptom may be sudden death, and ICD is not  
free of collateral problems and certainly not an easy decision for an  
asymptomatic 40 year old



  Thank you


  Ramon Brugada MD FACC
  Associate Professor of Medicine
  Canadian Research Chair Genetics of Arrhythmias
  University of Montreal
  Director Clinical Cardiovascular Genetics Center
  Montreal Heart Institute
  5000 Rue Belanger
  Montreal, QC H1T 1C8
  Canada
  ramon在brugada.org


--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee