[SCD-FORUM] 39E RE: Asymptomatic patient with Brugada syndrome. Dr. Li Zhang

[SCD Symposium]

Then we should ask oursselves why is so Dr. Ramon Brugada. Without a  
clear understanding of the disease nature, we may be always in the  
dark in terms of risk stratification. If Brugada syndrome were a  
primary repolarization disorder, one would expect the repolarization  
instability such as microvolt T wave alternans prior to the onset of  
VT/VF. As a matter of fact, the majority of VT/VF patients showed  
positive late potentials ( Arch Cardiol Mex. 2006 Jan-Mar;76(1): 
52-8 ). Recently Dr. Shimizu's group demonstrated both depolarization  
and repolarization abnormalities [ Pacing Clin Electrophysiol. 2006  
Oct;29(10):1112-21]. In the past our main focus was the consequence  
of reduced INa to the phase 1 repolarization in the RV epicardium and  
the transmural dispersion of repolarization, which may be part of the  
story. The slow activation propagation in ROVT region due to reduced  
sodium current itself should not be overlooked Am J Physiol Heart  
Circ Physiol. 2006 Jul 28; [Epub ahead of print]
.
Channelopathies especially SCN5A mutations can lead to structural  
abnormalities although many are undetectable by routine work up.  
Those structural alterations (macroscopic or microscopic) could also  
be the substrate to re-entrant ventricular tachyarrhythmias and  
sudden VT/VF death.

Sincerely,

Li Zhang, MD
LDS Hospital,
University of Utah School of Medicine
Salt Lake City, UT
USA

>
> No that i know of. There are two studies which looked at TWA (Japan  
> and
> Germany) in Brugada syndrome. Neither one showed any correlation  
> with risk.
>
> 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
>
>>
>> Dear Dr. Ramon Brugada,
>> As you have discussed in the answer to the question for an  
>> asymptomatic
>> patient with brugada syndrome, the use of EPS to risk stratify
>> asymptomatic patient is very controversial. The first symptom may be
>> sudden death in such patients. In such a scenario is there any  
>> role for
>> microvolt T wave alternans for risk stratifications and to decide  
>> the need
>> for ICD?
>>
>> Dr. Sunil Roy.  MD, DM
>> Senior Lecturer in Cardiology
>> Medical college, Calicut, Kerala, India
>> Email: sunilroytn at calicutmedicalcollege.ac.in
>>
>>
>
>

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee




-------------- next part --------------
An HTML attachment was scrubbed...
URL: http://www.grupoakros.com.ar/pipermail/scd-forum/attachments/20061016/dcb1ef7e/attachment.html