<HTML><BODY style="word-wrap: break-word; -khtml-nbsp-mode: space; -khtml-line-break: after-white-space; "><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">Dear Marcellus Francis Ramirez from Mannila Philippines: Here Andrés Ricardo Pérez Riera from Sao Paulo Brazil answer. I think that your patient has high risk of SCD.</SPAN></FONT></DIV><DIV style="text-align: justify;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">First dear colleague you live in a Country were the disease is endemic. </SPAN></FONT>In <FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">Philippines</SPAN></FONT>, the entity is known as Bangungut (wailing followed by SCD during sleep) <FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"> </SPAN></FONT>The death certificate classification of sudden unexplained nocturnal deaths (SUDS) in Manila has changed considerably, obscuring an increase in incidence. SUDS appears to be a regional phenomenon in Southeast Asia and environmental causes are likely because the deaths are seasonal, increased over the timespan studied, and are more common among migrants to Manila than among those born there. A high incidence of SUND has been reported among young Asian males. These deaths are known as Pokkuri in Japan, Bangungut in the Philippines and SUND in the USA. <B>SUNDS AND BRUGADA DISEASE ARE THE SAME DISEASE.</B></DIV><DIV style="text-align: justify;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">You say that the patient has spontaneous ECG type 1 pattern and additionally he belongs to male gender. Male gender predicts a more malignant natural history.</SPAN></FONT></DIV><DIV style="text-align: justify;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">Asymptomatic individuals with a spontaneous abnormal type 1 ECG developed an arrhythmic event during a mean follow-up period of only 27±29 months. A "spontaneous pattern" is defined as an ECG showing the patterns established for the first European Consensus about the syndrome (</SPAN></FONT><FONT class="Apple-style-span" color="#0032E6" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><B>1</B></SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">): presence of repolarization disorders occurred in the right precordial leads (V</SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="2"><SPAN class="Apple-style-span" style="font-size: 9.25px;">1</SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"> and V</SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="2"><SPAN class="Apple-style-span" style="font-size: 9.25px;">2</SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">) or in the anteroseptal wall (V</SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="2"><SPAN class="Apple-style-span" style="font-size: 9.25px;">1</SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"> to V</SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="2"><SPAN class="Apple-style-span" style="font-size: 9.25px;">3</SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">) with ST-segment</SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="2"><SPAN class="Apple-style-span" style="font-size: 9.25px;"> </SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">elevation coved to the top “coved type” or type 1A of my classification or rectilinear (type 1B of my classification) equal or mayor than 2mm (0.2mV), and followed by negative T wave (Brugada phenotype).</SPAN></FONT></DIV><DIV style="text-align: justify;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><BR class="khtml-block-placeholder"></SPAN></FONT></DIV><DIV style="text-align: justify;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">See the classification</SPAN></FONT></DIV><DIV style="text-align: auto;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><A href="http://www.scd-symposium.org/files/clasification.pdf">http://www.scd-symposium.org/files/clasification.pdf</A></DIV><DIV style="text-align: justify;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><BR class="khtml-block-placeholder"></SPAN></FONT></DIV><DIV style="text-align: justify;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">The following are markers of a poor prognosis in BrS patients:</SPAN></FONT></DIV><DIV style="text-align: justify; text-indent: -24px;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 42px; "><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">1)</SPAN></FONT><FONT class="Apple-style-span" face="Times New Roman" size="2"><SPAN class="Apple-style-span" style="font-size: 9.3px;"> </SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">Patients with an a spontaneously abnormal ECG type 1 pattern (Types 1A or 1B);</SPAN></FONT></DIV><DIV style="text-align: justify; text-indent: -24px;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 42px; "><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">2)</SPAN></FONT><FONT class="Apple-style-span" face="Times New Roman" size="2"><SPAN class="Apple-style-span" style="font-size: 9.3px;"> </SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"> Patients with inducibility of sustained ventricular arrhythmias at PES: concensus does not exist on the value of PES to identify the subjects with risk of spontaneous occurrence of VF. Brugada brothers think that theses patients should receive an ICD.(2-3) On the other hand, Priori et al from 200 patients using the life-table method</SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="2"><SPAN class="Apple-style-span" style="font-size: 9.25px;"> </SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">of Kaplan-Meier used to define the cardiac arrest-free interval</SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="2"><SPAN class="Apple-style-span" style="font-size: 9.25px;"> </SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">in patients undergoing PES failed to demonstrate an association</SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="2"><SPAN class="Apple-style-span" style="font-size: 9.25px;"> </SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">between PES inducibility and spontaneous occurrence of VF(</SPAN></FONT><FONT class="Apple-style-span" color="#0032E6" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><B>4</B></SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">) ; Eckardt et al</SPAN></FONT><FONT class="Apple-style-span" color="#F13934" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"> </SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">studied during a mean follow-up of 40 months a numerous universe of a collaborative large cohort 212 individuals who presented Brugada type 1 electrocardiographic pattern, from which 125 (59%) was spontaneous, and the rest only after pharmacological test with a class I drug. The authors verified that 58% were asymptomatic; 31% had suffered >/= 1episodes of syncope with unknown origin and 11% had been resuscitated from a VF episode (aborted sudden death). A history of syncope or aborted sudden death was predictor of adverse outcome. The degree of elevation of the T segment was greater between symptomatic individuals: 2.3 mm higher than asymptomatic ones (mean 1.9 mm ???: I think that this is a byes of the manuscript because type 1 is 2mm). In the latter, it was observed that the incidence of events was very low, and PES had a very low accuracy in predicting evolution. This paper attempts to clarify the controversial issue, which still persists, between Priori's group and Brugada's group, regarding the predictive value of PES, agreeing with the former.</SPAN></FONT><FONT class="Apple-style-span" color="#4B4B4B" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><I> </I></SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">The data regarding the risk of events in patients with BrS are controversial and depend on the cohort of patients studied. This collaborative paper describes long-term follow up of a large cohort of well-identified BrS patients as well as explores predictive value of PES. In contrary to some previous papers on the topic, in this study the authors could not demonstrate significant prognostic value of PES testing. The risk of arrhythmic events in asymptomatic patients is very low indicating that they could be considered as patients of much lesser risk than it was previously considered. This observation might have impact on both diagnostic triage and therapy approach in BrS patients (pharmacological approach).</SPAN></FONT></DIV><DIV style="text-align: justify; text-indent: -24px;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 42px; "><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">3)</SPAN></FONT><FONT class="Apple-style-span" face="Times New Roman" size="2"><SPAN class="Apple-style-span" style="font-size: 9.3px;"> </SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">Male gender predict a more malignant natural history;</SPAN></FONT></DIV><DIV style="text-align: justify; text-indent: -24px;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 42px; "><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">4)</SPAN></FONT><FONT class="Apple-style-span" face="Times New Roman" size="2"><SPAN class="Apple-style-span" style="font-size: 9.3px;"> </SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">Symptomatic patients: A history of syncope or aborted sudden death is predictor of adverse outcome.</SPAN></FONT></DIV><DIV style="text-align: justify; text-indent: -24px;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 42px; "><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">5)</SPAN></FONT><FONT class="Apple-style-span" face="Times New Roman" size="2"><SPAN class="Apple-style-span" style="font-size: 9.3px;"> </SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">Spontaneous</SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="2"><SPAN class="Apple-style-span" style="font-size: 9.25px;"> </SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">ST-segment elevation in leads V</SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="2"><SPAN class="Apple-style-span" style="font-size: 9.25px;">1</SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"> through V</SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="2"><SPAN class="Apple-style-span" style="font-size: 9.25px;">3</SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"> combined with the</SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="2"><SPAN class="Apple-style-span" style="font-size: 9.25px;"> </SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">history of syncope is a powerful marker to identify individuals</SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="2"><SPAN class="Apple-style-span" style="font-size: 9.25px;"> </SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">who had cardiac arrest.</SPAN></FONT></DIV><DIV style="text-align: justify; text-indent: -24px;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 42px; "><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">6)</SPAN></FONT><FONT class="Apple-style-span" face="Times New Roman" size="2"><SPAN class="Apple-style-span" style="font-size: 9.3px;"> </SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">A spontaneous change in ST segment is associated with the highest risk for subsequent events in subjects with a Brugada-type 1 ECG. The presence of syncopal episodes, a history of familial sudden death, and/or LP may increase its value </SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><B>(</B></SPAN></FONT><FONT class="Apple-style-span" color="#0032E6" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><B>6</B></SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><B>).</B></SPAN></FONT></DIV><DIV style="text-align: justify; text-indent: -24px;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 42px; "><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">7)</SPAN></FONT><FONT class="Apple-style-span" face="Times New Roman" size="2"><SPAN class="Apple-style-span" style="font-size: 9.3px;"> </SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">A history of syncope or SCD, the presence of a spontaneous Type 1 Brugada ECG, and male gender predict a more malignant natural history. The use of a family history of SCD, the presence of an SCN5A gene mutation, or EPS to guide the management of patients with a Brugada ECG is not supported</SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><B>(</B></SPAN></FONT><FONT class="Apple-style-span" color="#0032E6" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><B>7</B></SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><B>);</B></SPAN></FONT></DIV><DIV style="text-align: justify; text-indent: -24px;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 42px; ">8)<FONT class="Apple-style-span" face="Times New Roman" size="2"><SPAN class="Apple-style-span" style="font-size: 9.3px;"> </SPAN></FONT><FONT class="Apple-style-span" color="#F13934"> </FONT>A genetic defect<FONT class="Apple-style-span" size="1"><SPAN class="Apple-style-span" style="font-size: 8.33333px;"> </SPAN></FONT>on the <I>SCN5A </I>gene is not associated with a higher risk<FONT class="Apple-style-span" size="1"><SPAN class="Apple-style-span" style="font-size: 8.33333px;"> </SPAN></FONT>of events, suggesting that genetic analysis is a most useful<FONT class="Apple-style-span" size="1"><SPAN class="Apple-style-span" style="font-size: 8.33333px;"> </SPAN></FONT>diagnostic parameter but it is not helpful for risk stratification<B>(</B><FONT class="Apple-style-span" color="#0032E6"><B>8</B></FONT><B>).</B></DIV><DIV style="text-align: justify;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">The Brugada phenotype ECG) is much more prevalent than the manifest BrS. Although invasive electrophysiologic investigations have been proposed as a risk stratifier, their value is controversial, and alternative noninvasive techniques may be preferred.</DIV><DIV style="text-align: justify;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">Ikeda et al (</SPAN></FONT><FONT class="Apple-style-span" color="#0032E6" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">6</SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">) sought a noninvasive strategy to detect a high-risk group in a long-term follow-up study of subjects with a Brugada-type ECG, and no history of cardiac arrest. The study enrolled 124 consecutive subjects with a Brugada-type ECG. Prognostic indices included: age; sex, a family history of SCD, syncopal episodes, a spontaneous coved-type ST-segment elevation, maximal magnitude of ST-segment elevation, a spontaneous change in ST segment, a mean QRSd, maximal QT interval, QT dispersion, LPs by SA-ECG, and TWAs. Of the 124 subjects, 20 consenting subjects had an ICD before follow-up. During a 40 +/- 19-month follow-up, 12 subjects (9.7%) reached one of the endpoints (SCD or VT). Of the 12 risk indices, a family history of SCD, syncopal episodes, a spontaneous coved-type ST-segment elevation, a spontaneous change in ST segment, and LP had significant values. In multivariate analysis, a spontaneous change in ST segment had the most significance (a relative hazard, 9.2; P = 0.036). Combined assessment of this index and other significant indices obtained higher positive predictive values (43-71%). The authors concluded that a spontaneous change in ST segment is associated with the highest risk for subsequent events in subjects with a Brugada-type ECG. The presence of syncopal episodes, a history of familial sudden death, and/or LP may increase its value.</SPAN></FONT></DIV><DIV style="text-align: justify;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><B>References</B></SPAN></FONT></DIV><DIV style="text-align: justify;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; min-height: 14px; "><BR></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 12px/normal Helvetica; min-height: 14px; "><BR></DIV><DIV style="text-align: justify; text-indent: -24px;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 48px; "><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><B>1)</B></SPAN></FONT><FONT class="Apple-style-span" face="Times New Roman" size="2"><SPAN class="Apple-style-span" style="font-size: 9.3px;"> </SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><B>Wilde AA, Antzelevitch C, Borggrefe M, Brugada J, Brugada R, Brugada P, Corrado D, Hauer RNm Kass RS, Nademanee K, Priori SG, Towbin JA. Proposed diagnostic criteria for the Brugada syndrome Eur Heart J 2002; 23:1648-1654.</B></SPAN></FONT></DIV><DIV style="text-align: justify; text-indent: -24px;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 48px; "><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><B>2)</B></SPAN></FONT><FONT class="Apple-style-span" face="Times New Roman" size="2"><SPAN class="Apple-style-span" style="font-size: 9.3px;"> </SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><B>Brugada P, Brugada R, Mont L, Rivero M, Geelen P, Brugada J. Natural history of Brugada syndrome: the prognostic value of Programmed electrical stimulation of the heart. J Electrophysiol 2003; 14: 455-457.</B></SPAN></FONT></DIV><DIV style="text-align: justify; text-indent: -24px;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 48px; "><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><B>3)</B></SPAN></FONT><FONT class="Apple-style-span" face="Times New Roman" size="2"><SPAN class="Apple-style-span" style="font-size: 9.3px;"> </SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><B>Brugada J, Brugada R, Brugada P. Right bundle-branch block and ST-segment elevation in leads V1 through V3: a marker for sudden death in patients without demonstrable structural heart disease. </B></SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><B><I>Circulation. </I></B></SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><B>1998; 97: 457–460.</B></SPAN></FONT></DIV><DIV style="text-align: justify; text-indent: -24px;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 48px; "><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><B>4)</B></SPAN></FONT><FONT class="Apple-style-span" face="Times New Roman" size="2"><SPAN class="Apple-style-span" style="font-size: 9.3px;"> </SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><B>Priori SG, Napolitano C, Gasparini M, et al. Natural history of Brugada syndrome: insights for risk stratification and management. Circulation. 2002; 105: 1342-1347.</B></SPAN></FONT></DIV><DIV style="text-align: justify; text-indent: -24px;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 48px; "><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><B>5)</B></SPAN></FONT><FONT class="Apple-style-span" face="Times New Roman" size="2"><SPAN class="Apple-style-span" style="font-size: 9.3px;"> </SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><B>Eckardt L, Probst V, Smits JP, Bahr ES, Wolpert C, Schimpf R, Wichter T, Boisseau P, Heinecke A, Breithardt G, Borggrefe M, Lemarec H, Bocker D, Wilde AA. Long-Term Prognosis of Individuals With Right Precordial ST-Segment-Elevation Brugada Syndrome.Circulation. 2005; 111: 257-262; 111: 257-263</B></SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">.</SPAN></FONT></DIV><DIV style="text-align: justify; text-indent: -24px;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 48px; "><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><B>6)</B></SPAN></FONT><FONT class="Apple-style-span" face="Times New Roman" size="2"><SPAN class="Apple-style-span" style="font-size: 9.3px;"> </SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><B>Ikeda T, Takami M, Sugi K, Noninvasive risk stratification of subjects with a Brugada-type electrocardiogram and no history of cardiac arrest. Ann Noninvasive Electrocardiol. 2005; 10:396-403.</B></SPAN></FONT></DIV><DIV style="text-align: justify; text-indent: -24px;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 48px; "><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><B>7)</B></SPAN></FONT><FONT class="Apple-style-span" face="Times New Roman" size="2"><SPAN class="Apple-style-span" style="font-size: 9.3px;"> </SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><B>Gehi AK, Duong TD, Metz LD, et al. Risk stratification of individuals with the brugada electrocardiogram: a meta-analysis. J Cardiovasc Electrophysiol. 2006; 17:577-583.</B></SPAN></FONT></DIV><DIV style="text-align: justify; text-indent: -24px;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 48px; "><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><B>8)</B></SPAN></FONT><FONT class="Apple-style-span" face="Times New Roman" size="2"><SPAN class="Apple-style-span" style="font-size: 9.3px;"> </SPAN></FONT><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"><B>Priori SG, Napolitano C, Gasparini M, et al. Natural history of Brugada syndrome: insights for risk stratification and management. Circulation. 2002; 105: 1342-1347.</B></SPAN></FONT></DIV><P style="margin: 0.0px 0.0px 0.0px 0.0px"><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;"> </SPAN></FONT></P><DIV style="text-align: justify;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">All the best</DIV><DIV style="text-align: justify;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Andrés Ricardo Pérez Riera.</DIV><DIV style="text-align: justify;margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><FONT class="Apple-style-span" face="Arial" size="4"><SPAN class="Apple-style-span" style="font-size: 13.3px;">Chief of Electro-Vectocardiology Sector of the Discipline of Cardiology, ABC Faculty of Medicine (FMABC), Foundation of ABC (FUABC) - Santo André - Sao Paulo - Brazil. Rua Sebastiao Afonso 885 - Zip Code: 044417-100- Jardim Miriam S.P Brazil- Phone: 5504-6243 Fax: 5506-0398</SPAN></FONT></DIV><DIV style="text-align: justify;"><BR></DIV><DIV><DIV>El 16/10/2006, a las 15:14, SCD Symposium escribió:</DIV><BR class="Apple-interchange-newline"><BLOCKQUOTE type="cite"><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Forum of the ISHNE Sudden Cardiac Death World-Wide Internet Symposium</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">______________________________________________________________________</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; min-height: 14px; "><BR></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Medtronic's free physician resource center:</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><A href="http://www.medtronicconnect.com">http://www.medtronicconnect.com</A></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">______________________________________________________________________</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; min-height: 14px; "><BR></DIV> <DIV>Congratulations and more power to the organizers of</DIV><DIV>this excellent symposium.</DIV><DIV>I would like to ask your expert opinion about a recent</DIV><DIV>patient I encountered: a male in his mid 30s with type</DIV><DIV>1 brugada ecg pattern, negative EPS for inducible VT</DIV><DIV>and no family history of sudden death. The said</DIV><DIV>patient is applying as a seaman (works as a ship crew</DIV><DIV>member). Can this patient be cleared for employment in</DIV><DIV>such occupation without risks?</DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV>MARCELLUS FRANCIS RAMIREZ</DIV><DIV>Universty of Santo Tomas</DIV><DIV>Manila, Philippines</DIV><BR><DIV> <SPAN class="Apple-style-span" style="border-collapse: separate; border-spacing: 0px 0px; color: rgb(0, 0, 0); font-family: Helvetica; font-size: 12px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; text-align: auto; -khtml-text-decorations-in-effect: none; text-indent: 0px; -apple-text-size-adjust: auto; text-transform: none; orphans: 2; white-space: normal; widows: 2; word-spacing: 0px; "><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">--</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Dr.<SPAN class="Apple-converted-space"> </SPAN>Sergio<SPAN class="Apple-converted-space"> </SPAN>Dubner</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">President<SPAN class="Apple-converted-space"> </SPAN>of<SPAN class="Apple-converted-space"> </SPAN>Scientific<SPAN class="Apple-converted-space"> </SPAN>Committee</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 13px/normal Lucida Grande; min-height: 16px; ; font-family: Lucida Grande; font-size: 13px; "><BR style="font-family: Lucida Grande; font-size: 13px; "></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Dr.<SPAN class="Apple-converted-space"> </SPAN>Edgardo<SPAN class="Apple-converted-space"> </SPAN>Schapachnik</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">President<SPAN class="Apple-converted-space"> </SPAN>of<SPAN class="Apple-converted-space"> </SPAN>Steering<SPAN class="Apple-converted-space"> </SPAN>Committee</DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV><BR class="khtml-block-placeholder"></DIV><BR class="Apple-interchange-newline"></SPAN> </DIV><BR><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">_______________________________________________</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Scd-forum mailing list</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><A href="mailto:Scd-forum@scd-symposium.org">Scd-forum@scd-symposium.org</A></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><A href="http://www.grupoakros.com.ar/mailman/listinfo/scd-forum">http://www.grupoakros.com.ar/mailman/listinfo/scd-forum</A></DIV> </BLOCKQUOTE></DIV><BR><DIV> <SPAN class="Apple-style-span" style="border-collapse: separate; border-spacing: 0px 0px; color: rgb(0, 0, 0); font-family: Helvetica; font-size: 12px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; text-align: auto; -khtml-text-decorations-in-effect: none; text-indent: 0px; -apple-text-size-adjust: auto; text-transform: none; orphans: 2; white-space: normal; widows: 2; word-spacing: 0px; "><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">--</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Dr.<SPAN class="Apple-converted-space"> </SPAN>Sergio<SPAN class="Apple-converted-space"> </SPAN>Dubner</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">President<SPAN class="Apple-converted-space"> </SPAN>of<SPAN class="Apple-converted-space"> </SPAN>Scientific<SPAN class="Apple-converted-space"> </SPAN>Committee</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 13px/normal Lucida Grande; min-height: 16px; ; font-family: Lucida Grande; font-size: 13px; "><BR style="font-family: Lucida Grande; font-size: 13px; "></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Dr.<SPAN class="Apple-converted-space"> </SPAN>Edgardo<SPAN class="Apple-converted-space"> </SPAN>Schapachnik</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">President<SPAN class="Apple-converted-space"> </SPAN>of<SPAN class="Apple-converted-space"> </SPAN>Steering<SPAN class="Apple-converted-space"> </SPAN>Committee</DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV><BR class="khtml-block-placeholder"></DIV><BR class="Apple-interchange-newline"></SPAN> </DIV><BR></BODY></HTML>