[SCD-FORUM] 32E RE: A patient with typical vasovagal syncope based on history and type II Brugada pattern. Dr. Ramon Brugada

[SCD Symposium]

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

>
> 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
>
>
> --
> Dr. Sergio Dubner
> President of Scientific Committee
>
> Dr. Edgardo Schapachnik
> President of Steering Committee
>
>
>
>
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