[SCD-FORUM] 32E RE:发生在Ⅱ型Brugada综合征的典型血管迷走性晕厥一例 —Ramon Brugada医师

[SCD Symposium]

32E RE:发生在Ⅱ型Brugada综合征的典型血管迷走性晕厥 
一例 —Ramon Brugada医师
Alizadeh医师：

作出这个判断并不容易。你通过氟卡胺诊断了I型 
Brugada综合征。对于一次晕厥的发生，你需要进行危 
险分层。倘若晕厥是心源性的，相当一部分患者的病 
程会有进展，并需要植入除颤器（这部分患者在随访 
过程中表现出心脏骤停的高发生率）。倘若晕厥是血 
管迷走性的，从随访到植入ICD，你也会有诸多选择。 
我们建议通过电生理检查来决定是否植入ICD。
就如同前面所讨论的，电生理检查不是十全十美的 
（但是到目前为止没有比它更好的方式），并且我能 
肯定的说直立倾斜试验对于晕厥也不是十全十美的。 
根据我们的经验，我们的确遇到典型的血管迷走性晕 
厥，心电图有问题，直立倾斜试验阳性，继而出现心 
脏停搏的病例。我建议进行遗传学检查，尤其是有相 
关家族史的患者。
谢谢！

Ramon Brugada医师，医学博士，美国心脏病学学会会员
医学教授
Canadian Research Chair Genetics of Arrhythmias
Montreal大学
Director Clinical Cardiovascular Genetics Center
蒙特利尔心脏协会
Belanger路5000号
蒙特利尔, QC H1T 1C8
加拿大
ramon at brugada.org
Sergio Dubner医师
科委会主席
Edgardo Schapachnik医师
组委会主席
毛晔译 王玲洁校

32E RE: A patient with typical vasovagal syncope based on history and  
type II Brugada pattern. Dr. Ramon Brugada
Dr Alizadeh:

This is not an easy decision. You have made a diagnosis of Brugada  
type I using flecainide. With a syncopal episode, you need to risk  
stratify the patient. If the syncopal episode is of cardiac origin,  
pretty much   everybody will go ahead and implant a defibrillator  
(high rate of cardiac   arrest at follow-up). If the syncopal episode  
is vasovagal, then you have again all the options, from follow-up to  
direct ICD implantation. We recommend   EPS to decide on implantation.
As previously discussed, EPS is not perfect (but so far it does not  
appear that there is anything better), and I am sure that neither is  
HUTT in syncope. According to our experience, we do have cases of  
typical   vasovagal syncope, suspicious ecg, positive HUTT and  
subsequent cardiac arrest. Genetic testing i do recommend, especially  
for the implications in   family members.
thank you

Dr. 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 at brugada.org

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee


>
> 13E：一例有典型血管迷走神经性晕厥病史、心电图呈
> II型Brugada形态的患者－Alizadeh医师：
>
> 首先感谢这次大会的组织者们！
>
> 我的问题是关于一例患者：有典型血管迷走神经性晕
> 厥病史，直立倾斜试验（HUTT）阳性，无心脏猝死家
> 族史，在无药物激发时，心电图可呈II型Brugada形态，
> 氟卡尼激发试验中呈I型Brugada形态。
>
> 您认为下一步评价是通过电生理检查还是基因学测定
> 呢？
>
> 对于有典型血管迷走性晕厥病史、心电图呈Ⅱ型
> Brugada形态的患者首选检查是什么？氟卡尼试验还是
> 直立倾斜试验（HUTT）？
>
> 致
>
> Hormoz Alizadeh 医师
>
> Rajaje心血管医学研究中心
>
> 起搏电生理中心
>
> 伊朗 德黑兰
>
> Sergio Dubner博士
>
> 科委会主席
>
> Edgardo Schapachnik博士
>
> 组委会主席
>
> 白英楠译 王玲洁校
>
>
>
> 13E  A patient with typical vasovagal syncope based on history and
> type II Brugada pattern. Dr. Alizadeh
>
> I would like to thank the organizers of this symposium
>
>     My question is about a patient with typical vasovagal syncope
>
> based on history and positive HUTT, negative family history for SCD,
>
> type II Brugada pattern without drug chalenge test and type I Brugada
>
> pattern in ECG after flecainide test.   Do you recommend further
> evaluation by electrophysiologic testing  or genetic study?   what is
> the first choice for a patient with typical vasovagal  syncope based
> on history and type II Brugada pattern? flecainide test  or HUTT.
>
>     Best regards
>
> Hormoz Alizadeh MD
>
> Department of Pacemaker and Electrophysiology
>
> Rajaie Cardiovascular Medical and Research Center
>
> Tehran, Iran
>