[SCD-FORUM] 78E RE: Brugada's pattern detection in a son of SCD's patient. Dr. Ramon Brugada

[SCD Symposium]

Every single patient who is symptomatic has been asymptomatic for  
several years, usually 40 .
Most, but not all, will have premonitory symptoms like syncope. From  
experience, at the time of the syncopal episode the majority have not  
requested medical advise (they were young and thought not to be  
important). In summary, the first symptom for which they seek medical  
help may be aborted cardiac arrest.To follow up an aymptomatic is an  
option, however, a small percentatge will die.

HOLTER
In a meeting a few years ago there was the discussion regarding the  
use of a reveal in Brugada patients. I quote one clinician who said  
at that time "Reveal in a patient with Brugada syndrome may show two  
things. 1- nothing 2- malignant arrhythmia causing sudden cardiac  
death".
Brugada patients are characterized by having minimal amount or  
arrhythmias, Holter will rarely show anything worrisome.

thanks

Ramon Brugada

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee





>
> I think asymptomathic patient with 1 type of Brugada syndrome need   
> in  follow up with ECG control, Holter and information to avoid  
> potentially dangerouse drugs and conditions: antyarrhythmic drugs  
> (Na blockers),  high temperature, rapid vagus stimulation vagus  
> (diving and other). One of our patients with transient 1 type of  
> Brugada symptom had synsope only during eating and high temperature.
> Leonid Makarov M.D., PhD. Professor of Medicine (Pediatry). Moscow  
> Institute pediatry and children surgery. Center for children  
> arrhythmia, Dpt diagnostic of arrhythmia.
> 125412 Moscow, Taldomskaa str. 2 Russsia leo at oss.ru
>
> --
> Dr. Sergio Dubner
> President of Scientific Committee
>
> Dr. Edgardo Schapachnik
> President of Steering Committee
>
>
>>
>> If type I ecg is present, pharmacologic test is not indicated, the  
>> diagnosis
>> is made.
>>
>> Some investigators will go ahead and implant a defibrillator,  
>> because of the
>> family history
>>
>> Others will wait until he develops any symptoms
>>
>> I recommend an EPS to risk stratify. If positive then ICD implant.
>>
>>
>> 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
>>
>>
>>>
>>> Dear Sergio,
>>> About a case of reanimation of sudden death in a 54-year-old  
>>> patient, with no structural heart disease, with all the studies  
>>> made: coronary angiography, MNR, Holter, EPS.
>>> Everything appears to be normal. Monomorphic arrhythmic storm is  
>>> detected at the moment the patient is admitted. The patient is  
>>> provided life support and he recovers in 24 hs. ICD implantation  
>>> is decided. After three months he displays three shocks by  
>>> arrhythmic storm, incessant ventricular tachycardia. Mapping and  
>>> focus ablation is decided, in outflow tract with mismatch.
>>> To this moment, the patient has not displayed any event. It's  
>>> been three months, and in a Holter register in one of his sons,  
>>> typical Brugada pattern is observed. The patient is 17 years old,  
>>> asymptomatic. I cannot perform pharmacological test. What should  
>>> I do next?
>>>
>>> Dr. Cagnolatti  <drcagnolattia at hotmail.com>
>>>

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