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Lenarczyk R, Zeppenfeld K, Tfelt-Hansen J, Heinzel FR, Deneke T, Ene E, Meyer C, Wilde A, Arbelo E, Jędrzejczyk-Patej E, Sabbag A, Stühlinger M, di Biase L, Vaseghi M, Ziv O, Bautista-Vargas WF, Kumar S, Namboodiri N, Henz BD, Montero-Cabezas J, Dagres N. Management of patients with an electrical storm or clustered ventricular arrhythmias: a clinical consensus statement of the European Heart Rhythm Association of the ESC-endorsed by the Asia-Pacific Heart Rhythm Society, Heart Rhythm Society, and Latin-American Heart Rhythm Society. Europace 2024; 26:euae049. [PMID: 38584423 PMCID: PMC10999775 DOI: 10.1093/europace/euae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 04/09/2024] Open
Abstract
Electrical storm (ES) is a state of electrical instability, manifesting as recurrent ventricular arrhythmias (VAs) over a short period of time (three or more episodes of sustained VA within 24 h, separated by at least 5 min, requiring termination by an intervention). The clinical presentation can vary, but ES is usually a cardiac emergency. Electrical storm mainly affects patients with structural or primary electrical heart disease, often with an implantable cardioverter-defibrillator (ICD). Management of ES requires a multi-faceted approach and the involvement of multi-disciplinary teams, but despite advanced treatment and often invasive procedures, it is associated with high morbidity and mortality. With an ageing population, longer survival of heart failure patients, and an increasing number of patients with ICD, the incidence of ES is expected to increase. This European Heart Rhythm Association clinical consensus statement focuses on pathophysiology, clinical presentation, diagnostic evaluation, and acute and long-term management of patients presenting with ES or clustered VA.
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Affiliation(s)
- Radosław Lenarczyk
- Medical University of Silesia, Division of Medical Sciences, Department of Cardiology and Electrotherapy, Silesian Center for Heart Diseases, Skłodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- The Department of Forensic Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frank R Heinzel
- Cardiology, Angiology, Intensive Care, Städtisches Klinikum Dresden Campus Friedrichstadt, Dresden, Germany
| | - Thomas Deneke
- Clinic for Interventional Electrophysiology, Heart Center RHÖN-KLINIKUM Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
- Clinic for Electrophysiology, Klinikum Nuernberg, University Hospital of the Paracelsus Medical University, Nuernberg, Germany
| | - Elena Ene
- Clinic for Interventional Electrophysiology, Heart Center RHÖN-KLINIKUM Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Christian Meyer
- Division of Cardiology/Angiology/Intensive Care, EVK Düsseldorf, Teaching Hospital University of Düsseldorf, Düsseldorf, Germany
| | - Arthur Wilde
- Department of Cardiology, Amsterdam UMC University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and arrhythmias, Amsterdam, the Netherlands
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; IDIBAPS, Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ewa Jędrzejczyk-Patej
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Avi Sabbag
- The Davidai Center for Rhythm Disturbances and Pacing, Chaim Sheba Medical Center, Tel Hashomer, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Markus Stühlinger
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Luigi di Biase
- Albert Einstein College of Medicine at Montefiore Hospital, New York, NY, USA
| | - Marmar Vaseghi
- UCLA Cardiac Arrythmia Center, Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Ohad Ziv
- Case Western Reserve University, Cleveland, OH, USA
- The MetroHealth System Campus, Cleveland, OH, USA
| | | | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | | | - Benhur Davi Henz
- Instituto Brasilia de Arritmias-Hospital do Coração do Brasil-Rede Dor São Luiz, Brasilia, Brazil
| | - Jose Montero-Cabezas
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Eckardt L, Veltmann C. More than 30 years of Brugada syndrome: a critical appraisal of achievements and open issues. Herzschrittmacherther Elektrophysiol 2024; 35:9-18. [PMID: 38085327 DOI: 10.1007/s00399-023-00983-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2023] [Indexed: 02/21/2024]
Abstract
Over the last three decades, what is referred to as Brugada syndrome (BrS) has developed from a clinical observation of initially a few cases of sudden cardiac death (SCD) in the absence of structural heart disease with ECG signs of "atypical right bundle brunch block" to a predominantly electrocardiographic, and to a lesser extent genetic, diagnosis. Today, BrS is diagnosed in patients without overt structural heart disease and a spontaneous Brugada type 1 ECG pattern regardless of symptoms. The diagnosis of BrS is less clear in those with an only transient or drug-induced type 1 Brugada pattern, but should be considered in the presence of an arrhythmic syncope, family history of BrS, or family history of sudden death. In addition to survived cardiac arrest, syncope is probably the single most decisive risk marker for future arrhythmias. For asymptomatic BrS, risk stratification remains challenging. General recommendations to lower the risk in BrS include avoidance of drugs/agents known to induce and/or increase right precordial ST-segment elevation, including treatment of fever with antipyretic drugs. Several ECG markers that have been associated with an increased risk of SCD have been incorporated into a recently published risk score for BrS. The aim of this article is to provide an overview of the status of risk stratification and to illustrate open issues und gaps in evidence in BrS.
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Affiliation(s)
- Lars Eckardt
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany.
- Klinik für Kardiologie II-Rhythmologie, Universitätsklinikum Münster, Münster, Germany.
| | - Christian Veltmann
- Heart Center Bremen, Electrophysiology Bremen, Klinikum Links der Weser, Bremen, Germany
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Trohman RG. Etiologies, Mechanisms, Management, and Outcomes of Electrical Storm. J Intensive Care Med 2024; 39:99-117. [PMID: 37731333 DOI: 10.1177/08850666231192050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Electrical storm (ES) is characterized by three or more discrete sustained ventricular tachyarrhythmia episodes occurring within a limited time frame (generally ≤ 24 h) or an incessant ventricular tachyarrhythmia lasting > 12 h. In patients with an implantable cardioverterdefibrillator (ICD), ES is defined as three or more appropriate device therapies, separated from each other by at least 5 min, which occur within a 24-h period. ES may constitute a medical emergency, depending on the number arrhythmic episodes, their duration, the type, and the cycle length of the ventricular arrhythmias, as well as the underlying ventricular function. This narrative review was facilitated by a search of MEDLINE to identify peer-reviewed clinical trials, randomized controlled trials, meta-analyses, and other clinically relevant studies. The search was limited to English-language reports published between 1999 and 2023. ES was searched using the terms mechanisms, genetics, channelopathies, management, pharmacological therapy, sedation, neuraxial modulation, cardiac sympathetic denervation, ICDs, and structural heart disease. Google and Google scholar as well as bibliographies of identified articles were reviewed for additional references. This manuscript examines the current strategies available to treat ES and compares pharmacological and invasive treatment strategies to diminish ES recurrence, morbidity, and mortality.
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Affiliation(s)
- Richard G Trohman
- Section of Electrophysiology, Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
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Hsu CH, Lin SH, Chang LY. Anesthesia in patients with Brugada syndrome: two case reports. J Med Case Rep 2023; 17:275. [PMID: 37322558 DOI: 10.1186/s13256-023-03934-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/17/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Brugada syndrome is a rare disease. It causes sudden cardiac arrest, which is a serious life-threatening event. Sudden cardiac death mostly results from coronary artery disease. However, patients with Brugada syndrome show normal cardiac anatomy and no evidence of ischemia or electrolyte imbalance. Anesthesia in patients with Brugada syndrome is challenging due to its unpredictable nature, and is worth our attention. CASE PRESENTATION We report two cases of Brugada syndrome during anesthesia. In case one, a 31-year-old Filipino laborer was scheduled for laparoscopic appendectomy. The patient denied any preexisting cardiac disease. The preoperative vital signs were stable, with mild fever of 37.9 °C. The operation was smooth. During the emergence period, the patient suffered from sudden onset of ventricular tachycardia. After resuscitation, the cardiac rhythm returned to normal. Later, he was confirmed to have a genetic trait of Brugada syndrome. In case two, a young Taiwanese patient with pre-diagnosed Brugada syndrome underwent an operation. The perioperative precautions were taken to prevent the occurrence of ventricular arrhythmia. The surgery was uneventful. CONCLUSIONS Brugada syndrome, although rare, has the highest incidence in South East Asian healthy young males. It brings attention to possible fatal cardiac arrhythmia in this population. Careful preoperative evaluation and perioperative management can help reduce the harmful outcome of the disease and prevent any untoward events.
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Affiliation(s)
- Che-Hao Hsu
- Department of Anesthesiology, Tungs' Taichung MetroHarbor Hospital, Taichung, 43503, Taiwan.
| | - Shin-Hong Lin
- Department of Anesthesiology, Tungs' Taichung MetroHarbor Hospital, Taichung, 43503, Taiwan
| | - Li-Yen Chang
- Department of Anesthesiology, Tungs' Taichung MetroHarbor Hospital, Taichung, 43503, Taiwan
- Department of Anesthesiology, Taichung Armed Forces General Hospital, Taichung, 41169, Taiwan
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Viskin S, Rosso R. Treatment of Brugada Syndrome in 2023: Know Where You Come From to Know Where You Are Going. Circulation 2023; 147:1579-1581. [PMID: 37216435 DOI: 10.1161/circulationaha.123.064673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Sami Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
| | - Raphael Rosso
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
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Di Diego JM, Barajas-Martinez H, Cox R, Robinson VM, Jung J, Fouda M, Patocskai B, Abdelsayed M, Ruben PC, Antzelevitch C. Mechanisms underlying the antiarrhythmic effect of ARumenamide-787 in experimental models of the J wave syndromes and hypothermia. PLoS One 2023; 18:e0281977. [PMID: 37159454 PMCID: PMC10168548 DOI: 10.1371/journal.pone.0281977] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 02/05/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Brugada (BrS) and early repolarization syndromes (ERS), the so-called J wave syndromes (JWS), are associated with life-threatening ventricular arrhythmias. Pharmacologic approaches to therapy are currently limited. In this study, we examine the effects of ARumenamide-787 (AR-787) to suppress the electrocardiographic and arrhythmic manifestations of JWS and hypothermia. METHODS We studied the effects of AR-787 on INa and IKr in HEK-293 cells stably expressing the α- and β1-subunits of the cardiac (NaV1.5) sodium channel and hERG channel, respectively. In addition, we studied its effect on Ito, INa and ICa in dissociated canine ventricular myocytes along with action potentials and ECG from coronary-perfused right (RV) and left (LV) ventricular wedge preparations. The Ito agonist, NS5806 (5-10 μM), ICa blocker, verapamil (2.5 μM), and INa blocker, ajmaline (2.5 μM), were used to mimic the genetic defects associated with JWS and to induce the electrocardiographic and arrhythmic manifestations of JWS (prominent J waves/ST segment elevation, phase 2 reentry and polymorphic VT/VF) in canine ventricular wedge preparations. RESULTS AR-787 (1, 10 and 50 μM) exerted pleiotropic effects on cardiac ion channels. The predominant effect was inhibition of the transient outward current (Ito) and enhancement of the sodium channel current (INa), with lesser effects to inhibit IKr and augment calcium channel current (ICa). AR-787 diminished the electrocardiographic J wave and prevented and/or suppressed all arrhythmic activity in canine RV and LV experimental models of BrS, ERS and hypothermia. CONCLUSIONS Our findings point to AR-787 as promising candidate for the pharmacologic treatment of JWS and hypothermia.
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Affiliation(s)
- José M. Di Diego
- Lankenau Institute for Medical Research, Wynnewood, PA, United States of America
| | - Hector Barajas-Martinez
- Lankenau Institute for Medical Research, Wynnewood, PA, United States of America
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Robert Cox
- Lankenau Institute for Medical Research, Wynnewood, PA, United States of America
| | - Victoria M. Robinson
- Lankenau Institute for Medical Research, Wynnewood, PA, United States of America
| | - Joseph Jung
- Lankenau Institute for Medical Research, Wynnewood, PA, United States of America
| | | | - Bence Patocskai
- Lankenau Institute for Medical Research, Wynnewood, PA, United States of America
| | | | | | - Charles Antzelevitch
- Lankenau Institute for Medical Research, Wynnewood, PA, United States of America
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States of America
- Lankenau Heart Institute, Wynnewood, PA, United States of America
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Giustetto C, Cerrato N, Dusi V, Angelini F, De Ferrari G, Gaita F. The Brugada syndrome: pharmacological therapy. Eur Heart J Suppl 2023; 25:C32-C37. [PMID: 37125314 PMCID: PMC10132564 DOI: 10.1093/eurheartjsupp/suad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Brugada syndrome is an inherited channelopathy with an increased risk of sudden cardiac death (SCD) due to ventricular arrhythmias (VA) and an increased incidence of supraventricular arrhythmias, as compared with the general population. For the prevention of SCD, the guidelines recommend the implantable cardioverter-defibrillator (ICD); however, ICD does not prevent VA. In this article, we provide a brief review of the literature on the Brugada syndrome pharmacological therapy, mainly focusing on quinidine treatment. The efficacy of quinidine therapy in the prevention of VA in Brugada syndrome has been demonstrated by several small studies in patients with ICD and recurrent shocks or in asymptomatic patients with inducible ventricular fibrillation (VF) at electrophysiological study. Quinidine has also been tested for the prophylaxis of supraventricular arrhythmias, especially atrial fibrillation/flutter, and in paediatric patients. In these studies, quinidine proved highly effective in preventing re-induction of VF and spontaneous recurrences of both ventricular and supraventricular arrhythmias. Unfortunately, this therapy is burdened by a high incidence of side effects, which may lead to drug discontinuation.
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Affiliation(s)
- Carla Giustetto
- Corresponding author. Tel: +390116709596, Fax:+390112366656,
| | - Natascia Cerrato
- Division of Cardiology, Cardinal G. Massaia Hospital, 14100 Asti, Italy
| | - Veronica Dusi
- Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, C.so Bramante, 88. 10126, Turin, Italy
- Department of Medical Sciences, University of Turin, C. so Dogliotti, 14, 10126, Turin, Italy
| | - Filippo Angelini
- Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, C.so Bramante, 88. 10126, Turin, Italy
| | - Gaetano De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, C.so Bramante, 88. 10126, Turin, Italy
- Department of Medical Sciences, University of Turin, C. so Dogliotti, 14, 10126, Turin, Italy
| | - Fiorenzo Gaita
- Department of Medical Sciences, University of Turin, C. so Dogliotti, 14, 10126, Turin, Italy
- Maria Pia Hospital, GVM Care & Research, 10132 Torino, Italy
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Bergeman AT, Postema PG, Wilde AAM, van der Werf C. Pharmacological treatment of short-coupled idiopathic ventricular fibrillation: A review. Indian Pacing Electrophysiol J 2023; 23:77-83. [PMID: 36933619 PMCID: PMC10160784 DOI: 10.1016/j.ipej.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/11/2023] [Accepted: 03/15/2023] [Indexed: 03/18/2023] Open
Abstract
Short-coupled idiopathic ventricular fibrillation (IVF) is a subtype of IVF in which episodes of polymorphic ventricular tachycardia or ventricular fibrillation are initiated by short-coupled premature ventricular contractions (PVCs). Our understanding of the pathophysiology is evolving, with evidence suggesting that these malignant PVCs originate from the Purkinje system. In most cases, the genetic underpinning has not been identified. Whereas the implantation of an implantable cardioverter-defibrillator is uncontroversial, the choice of pharmacological treatment is the subject of discussion. In this review, we summarize the available knowledge on pharmacological therapy in short-coupled IVF and provide our recommendations for management of patients with this syndrome.
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Affiliation(s)
- A T Bergeman
- Heart Centre, Department of Cardiology, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
| | - P G Postema
- Heart Centre, Department of Cardiology, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
| | - A A M Wilde
- Heart Centre, Department of Cardiology, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
| | - C van der Werf
- Heart Centre, Department of Cardiology, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands.
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El-Battrawy I, Roterberg G, Kowitz J, Aweimer A, Lang S, Mügge A, Zhou X, Akin I. Incidence, recurrence and management of electrical storm in Brugada syndrome. Front Cardiovasc Med 2022; 9:981715. [PMID: 36386327 PMCID: PMC9640734 DOI: 10.3389/fcvm.2022.981715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/04/2022] [Indexed: 11/30/2022] Open
Abstract
Background Brugada syndrome (BrS) is associated with ventricular tachyarrhythmias. However, the presence of electrical strom (ES) and its management still debated. Objectives We present the outcome and management of 44 BrS patients suffering from ES. Methods A systematic literature review and pooled analysis Through database review including PubMed, Web of Science, Cochrane Libary and Cinahl studies were analyzed. Evidence from 7 reports of 808 BrS patients was identified. Results The mean age of patients suffering from ES was 34 ± 9.5 months (94.7% males, 65.8% spontaneous BrS type I). Using electrophysiological study ventricular tachycardia/ventricular fibrillation were inducible in 12/23 (52.2%). Recurrence of ES was documented in 6.1%. Death from ES was 8.2% after a follow-up of 83.5 ± 53.4. In up to 27 ES resolved without treatment. External shock was required in 35.6%, internal ICD shock in 13.3%, Overdrive pacing, left cardiac sympathetic block and atropin in 2.2%. Short-term antiarrhythmic management was as the following: Isopreterenol or Isopreterenol in combination with quinidine 35.5%, orciprenaline in 2.2%, quinidine 2.2%, disopyramide 2.2% or denopamide 2.2%. However, lidocaine, magensium sulfate, mexiletine and propanolol failed to control ES. Conclusion Although ES is rare in BrS, this entity challenges physicians. Despite its high mortality rate, spontaneous termination is possible. Short-term management using Isoproterenol and/or quinidine might be safe. Prospective studies on management of ES are warranted.
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Affiliation(s)
- Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
- DZHK (German Center for Cardiovascular Research), Mannheim, Germany
- Bergmannsheil Bochum, Medical Clinic II, Department of Cardiology and Angiology, Ruhr University, Bochum, Germany
- *Correspondence: Ibrahim El-Battrawy
| | - Gretje Roterberg
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Jacqueline Kowitz
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Assem Aweimer
- Bergmannsheil Bochum, Medical Clinic II, Department of Cardiology and Angiology, Ruhr University, Bochum, Germany
| | - Siegfried Lang
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
- DZHK (German Center for Cardiovascular Research), Mannheim, Germany
| | - Andreas Mügge
- Bergmannsheil Bochum, Medical Clinic II, Department of Cardiology and Angiology, Ruhr University, Bochum, Germany
| | - Xiaobo Zhou
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
- DZHK (German Center for Cardiovascular Research), Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
- DZHK (German Center for Cardiovascular Research), Mannheim, Germany
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Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, Charron P, Corrado D, Dagres N, de Chillou C, Eckardt L, Friede T, Haugaa KH, Hocini M, Lambiase PD, Marijon E, Merino JL, Peichl P, Priori SG, Reichlin T, Schulz-Menger J, Sticherling C, Tzeis S, Verstrael A, Volterrani M. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022; 43:3997-4126. [PMID: 36017572 DOI: 10.1093/eurheartj/ehac262] [Citation(s) in RCA: 686] [Impact Index Per Article: 343.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Pharmacologic Management for Ventricular Arrhythmias: Overview of Anti-Arrhythmic Drugs. J Clin Med 2022; 11:jcm11113233. [PMID: 35683620 PMCID: PMC9181251 DOI: 10.3390/jcm11113233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/17/2022] [Accepted: 05/28/2022] [Indexed: 01/27/2023] Open
Abstract
Ventricular arrhythmias (Vas) are a life-threatening condition and preventable cause of sudden cardiac death (SCD). With the increased utilization of implantable cardiac defibrillators (ICD), the focus of VA management has shifted toward reduction of morbidity from VAs and ICD therapies. Anti-arrhythmic drugs (AADs) can be an important adjunct therapy in the treatment of recurrent VAs. In the treatment of VAs secondary to structural heart disease, amiodarone remains the most well studied and current guideline-directed pharmacologic therapy. Beta blockers also serve as an important adjunct and are a largely underutilized medication with strong evidentiary support. In patients with defined syndromes in structurally normal hearts, AADs can offer tailored therapies in prevention of SCD and improvement in quality of life. Further clinical trials are warranted to investigate the role of newer therapeutic options and for the direct comparison of established AADs.
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Belhassen B, Tovia-Brodie O. Short-Coupled Idiopathic Ventricular Fibrillation: A Literature Review With Extended Follow-Up. JACC Clin Electrophysiol 2022; 8:918-936. [PMID: 35597766 DOI: 10.1016/j.jacep.2022.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/25/2022] [Accepted: 04/18/2022] [Indexed: 01/07/2023]
Abstract
Idiopathic ventricular fibrillation is responsible for approximately 10% of cases of aborted cardiac arrest. Recent studies have shown that short-coupled ventricular premature complexes are present at the onset of idiopathic ventricular fibrillation in 6.6%-17% of patients. The present review provided information on 86 patients with short-coupled malignant ventricular arrhythmias that were reported as case reports or small patient series during the last 70 years. In 75% of the 81 cases published during the last 40 years, extended information and follow-up (from 2.63 ± 4.5 to 10.67 ± 7.8 years; P < 0.001, between the original publication to the latest update) could be obtained from the authors. The review shows that short-coupled malignant ventricular arrhythmias occurred almost equally in males and females, at the mean age of 40 years. A tendency for later occurrence of the arrhythmia by 4 years was observed in females. A prior history of syncope was noted in 45.3% of the patients, whereas arrhythmic storm occurred in 42% at presentation. The most common mode of revelation of short-coupled malignant ventricular arrhythmias was syncope (53.5%), followed by aborted cardiac arrest (26.7%) and recurrent arrhythmic event after prior implantable-cardioverter defibrillator implantation for idiopathic ventricular fibrillation (17.4%). For the first time, short-coupled malignant arrhythmias exhibiting "not-so-short" coupling intervals (≥350 ms) were found in a significant proportion of patients (17.4%). During long-term follow-up, quinidine yielded a slightly higher success rate in arrhythmia control than ablation. Larger studies are necessary to assess the best strategy for the management of this potentially lethal arrhythmia.
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Affiliation(s)
- Bernard Belhassen
- Heart Institute, Hadassah Medical Center, Jerusalem, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Oholi Tovia-Brodie
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
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Zimmermann P, Aberer F, Braun M, Sourij H, Moser O. The Arrhythmogenic Face of COVID-19: Brugada ECG Pattern in SARS-CoV-2 Infection. J Cardiovasc Dev Dis 2022; 9:jcdd9040096. [PMID: 35448072 PMCID: PMC9027624 DOI: 10.3390/jcdd9040096] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 12/15/2022] Open
Abstract
In 1992, Brugada syndrome (BS) was first described; an often unrecognized cardiac conduction disorder mainly associated with unexplained sudden cardiac arrest and consecutive syncope. Nevertheless, the pathomechanism of BS and sudden cardiac death remains mainly explained. Mutations in the cardiac sodium channels, which cause a reduction or functional loss of these channels, are associated with characteristic electrocardiographic (ECG) abnormalities and malignant arrhythmia. The majority of affected people are previously healthy and unaware of their genetic predisposition for BS and might experience ventricular tachyarrhythmias and cardiac arrest potentially triggered by several factors (e.g., alcohol, sodium channel blockers, psychotropic drugs, and fever). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was firstly identified in Wuhan in early December 2019 and rapidly spread worldwide as coronavirus disease (COVID-19). COVID-19 is typically characterized by a severe inflammatory response, activation of the immune system, and high febrile illness. Due to this condition, symptomatic COVID-19 infection or vaccination might serve as inciting factor for unmasking the Brugada pattern and represents a risk factor for developing proarrhythmic complications. The aim of this narrative review was to detail the association between virus-related issues such as fever, electrolyte disturbance, and inflammatory stress of COVID-19 infection with transient Brugada-like symptoms and ECG-pattern and its susceptibility to proarrhythmogenic episodes.
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Affiliation(s)
- Paul Zimmermann
- Department of Sport Science, Division of Exercise Physiology and Metabolism, University of Bayreuth, 95447 Bayreuth, Germany; (P.Z.); (O.M.)
- Department of Cardiology, Klinikum Bamberg, 96049 Bamberg, Germany;
| | - Felix Aberer
- Department of Sport Science, Division of Exercise Physiology and Metabolism, University of Bayreuth, 95447 Bayreuth, Germany; (P.Z.); (O.M.)
- Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria;
- Correspondence: ; Tel.: +43-316-385-86113
| | - Martin Braun
- Department of Cardiology, Klinikum Bamberg, 96049 Bamberg, Germany;
| | - Harald Sourij
- Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria;
| | - Othmar Moser
- Department of Sport Science, Division of Exercise Physiology and Metabolism, University of Bayreuth, 95447 Bayreuth, Germany; (P.Z.); (O.M.)
- Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria;
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14
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Ono K, Iwasaki YK, Akao M, Ikeda T, Ishii K, Inden Y, Kusano K, Kobayashi Y, Koretsune Y, Sasano T, Sumitomo N, Takahashi N, Niwano S, Hagiwara N, Hisatome I, Furukawa T, Honjo H, Maruyama T, Murakawa Y, Yasaka M, Watanabe E, Aiba T, Amino M, Itoh H, Ogawa H, Okumura Y, Aoki-Kamiya C, Kishihara J, Kodani E, Komatsu T, Sakamoto Y, Satomi K, Shiga T, Shinohara T, Suzuki A, Suzuki S, Sekiguchi Y, Nagase S, Hayami N, Harada M, Fujino T, Makiyama T, Maruyama M, Miake J, Muraji S, Murata H, Morita N, Yokoshiki H, Yoshioka K, Yodogawa K, Inoue H, Okumura K, Kimura T, Tsutsui H, Shimizu W. JCS/JHRS 2020 Guideline on Pharmacotherapy of Cardiac Arrhythmias. Circ J 2022; 86:1790-1924. [DOI: 10.1253/circj.cj-20-1212] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Yu-ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Masaharu Akao
- Department of Cardiovascular Medicine, National Hospital Organization Kyoto Medical Center
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine
| | - Kuniaki Ishii
- Department of Pharmacology, Yamagata University Faculty of Medicine
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshinori Kobayashi
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital
| | | | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | | | - Tetsushi Furukawa
- Department of Bio-information Pharmacology, Medical Research Institute, Tokyo Medical and Dental University
| | - Haruo Honjo
- Research Institute of Environmental Medicine, Nagoya University
| | - Toru Maruyama
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital
| | - Yuji Murakawa
- The 4th Department of Internal Medicine, Teikyo University School of Medicine, Mizonokuchi Hospital
| | - Masahiro Yasaka
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center
| | - Eiichi Watanabe
- Department of Cardiology, Fujita Health University School of Medicine
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Mari Amino
- Department of Cardiovascular Medicine, Tokai University School of Medicine
| | - Hideki Itoh
- Division of Patient Safety, Hiroshima University Hospital
| | - Hisashi Ogawa
- Department of Cardiology, National Hospital Organisation Kyoto Medical Center
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Chizuko Aoki-Kamiya
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center
| | - Jun Kishihara
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Eitaro Kodani
- Department of Cardiovascular Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Takashi Komatsu
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University School of Medicine
| | | | | | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University
| | - Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Yukio Sekiguchi
- Department of Cardiology, National Hospital Organization Kasumigaura Medical Center
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Noriyuki Hayami
- Department of Fourth Internal Medicine, Teikyo University Mizonokuchi Hospital
| | | | - Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University, Faculty of Medicine
| | - Takeru Makiyama
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Mitsunori Maruyama
- Department of Cardiovascular Medicine, Nippon Medical School Musashi Kosugi Hospital
| | - Junichiro Miake
- Department of Pharmacology, Tottori University Faculty of Medicine
| | - Shota Muraji
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | | | - Norishige Morita
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital
| | - Hisashi Yokoshiki
- Department of Cardiovascular Medicine, Sapporo City General Hospital
| | - Koichiro Yoshioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School
| | | | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
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15
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Elsokkari I, Tsuji Y, Sapp JL, Nattel S. Recent insights into mechanisms and clinical approaches to electrical storm. Can J Cardiol 2021; 38:439-453. [PMID: 34979281 DOI: 10.1016/j.cjca.2021.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/21/2021] [Accepted: 12/30/2021] [Indexed: 12/14/2022] Open
Abstract
Electrical storm, characterized by repetitive ventricular tachycardia/fibrillation (VT/VF) over a short period, is becoming commoner with widespread use of implantable cardioverter-defibrillator (ICD) therapy. Electrical storm, sometimes called "arrhythmic storm" or "VT-storm", is usually a medical emergency requiring hospitalization and expert management, and significantly affects short- and long-term outcomes. This syndrome typically occurs in patients with underlying structural heart disease (ischemic or non-ischemic cardiomyopathy) or inherited channelopathies. Triggers for electrical storm should be sought but are often unidentifiable. Initial management is dictated by the hemodynamic status, while subsequent management typically involves ICD interrogation and reprogramming to reduce recurrent shocks, identification/management of triggers like electrolyte abnormalities, myocardial ischemia, or decompensated heart failure, and antiarrhythmic-drug therapy or catheter ablation. Sympathetic nervous system activation is central to the initiation and maintenance of arrhythmic storm, so autonomic modulation is a cornerstone of management. Sympathetic inhibition can be achieved with medications (particularly beta-adrenoreceptor blockers), deep sedation, or cardiac sympathetic denervation. More definitive management targets the underlying ventricular arrhythmia substrate to terminate and prevent recurrent arrhythmia. Arrhythmia targeting can be achieved with antiarrhythmic medications, catheter ablation or more novel therapies such as stereotactic radiation therapy that targets the arrhythmic substrate. Mechanistic studies point to adrenergic activation and other direct consequences of ICD-shocks in promoting further arrhythmogenesis and hypocontractility. Here, we review the pathophysiologic mechanisms, clinical features, prognosis, and therapeutic options for electrical storm. We also outline a clinical approach to this challenging and complex condition, along with its mechanistic basis.
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Affiliation(s)
- Ihab Elsokkari
- University of Sydney, Nepean Blue Mountains local health district, Australia
| | - Yukiomi Tsuji
- Department of Physiology of Visceral Function, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - John L Sapp
- Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
| | - Stanley Nattel
- Departments of Medicine and Research Center, Montreal Heart Institute and Université de Montréal and Pharmacology and Therapeutics McGill University, Montreal, Quebec, Canada; Institute of Pharmacology, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany; IHU LIYRC Institute, Bordeaux, France.
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16
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Guarracini F, Casella M, Muser D, Barbato G, Notarstefano P, Sgarito G, Marini M, Grandinetti G, Mariani MV, Boriani G, Ricci RP, De Ponti R, Lavalle C. Clinical management of electrical storm: a current overview. J Cardiovasc Med (Hagerstown) 2021; 22:669-679. [PMID: 32925390 DOI: 10.2459/jcm.0000000000001107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The number of patients affected by electrical storm has been continuously increasing in emergency departments. Patients are often affected by multiple comorbidities requiring multidisciplinary interventions to achieve a clinical stability. Careful reprogramming of cardiac devices, correction of electrolyte imbalance, knowledge of underlying heart disease and antiarrhythmic drugs in the acute phase play a crucial role. The aim of this review is to provide a comprehensive overview of pharmacological treatment, latest transcatheter ablation techniques and advanced management of patients with electrical storm.
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Affiliation(s)
| | - Michela Casella
- Heart Rhythm Center, Centro Cardiologico Monzino, Milan.,Department of Clinical, Special and Dental Sciences, Cardiology and Arrhythmology Clinic, University Hospital 'UmbertoI-Lancisi-Salesi', Marche Polytechnic University, Ancona
| | - Daniele Muser
- Cardiothoracic Department, University Hospital of Udine, Udine
| | | | | | - Giuseppe Sgarito
- Cardiology Division, ARNAS Ospedale Civico e Benfratelli, Palermo
| | | | | | - Marco V Mariani
- Department of Cardiology, Policlinico Universitario Umberto I, Roma
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena
| | | | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo & Macchi Foundation, University of Insubria, Varese, Italy
| | - Carlo Lavalle
- Department of Cardiology, Policlinico Universitario Umberto I, Roma
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17
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Antzelevitch C, Di Diego JM. J wave syndromes: What's new? Trends Cardiovasc Med 2021; 32:350-363. [PMID: 34256120 PMCID: PMC8743304 DOI: 10.1016/j.tcm.2021.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/03/2021] [Accepted: 07/04/2021] [Indexed: 12/19/2022]
Abstract
Among the inherited ion channelopathies associated with potentially life-threatening ventricular arrhythmia syndromes in nominally structurally normal hearts are the J wave syndromes, which include the Brugada (BrS) and early repolarization (ERS) syndromes. These ion channelopathies are responsible for sudden cardiac death (SCD), most often in young adults in the third and fourth decade of life. Our principal goal in this review is to briefly outline the clinical characteristics, as well as the molecular, ionic, cellular, and genetic mechanisms underlying these primary electrical diseases that have challenged the cardiology community over the past two decades. In addition, we discuss our recently developed whole-heart experimental model of BrS, providing compelling evidence in support of the repolarization hypothesis for the BrS phenotype as well as novel findings demonstrating that voltage-gated sodium and transient outward current channels can modulate each other's function via trafficking and gating mechanisms with implications for improved understanding of the genetics of both cardiac and neuronal syndromes.
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Affiliation(s)
- Charles Antzelevitch
- Distinguished Professor Emeritus and Executive Director, Cardiovascular Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA; Lankenau Institute for Medical Research, Wynnwoddm PA USA; Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia PA, USA.
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18
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Zhao D, Liang B, Peng J, Tang L, Su R, Luo L, Deng B, Wang S. Long-term follow-up in patients with Brugada Syndrome in South China. Ann Noninvasive Electrocardiol 2021; 26:e12823. [PMID: 33417270 PMCID: PMC8164141 DOI: 10.1111/anec.12823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/16/2020] [Accepted: 11/24/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the presence of Brugada electrocardiogram (ECG) pattern, clinical characteristics, treatment, and long‐term prognosis of Brugada syndrome in southern Chinese population. Methods This prospective study consisted of a consecutive series of patients with diagnostic coved type I Brugada ECG pattern at baseline between January 2007 and February 2020. Histories of symptoms including ventricular tachycardia (VT)/ventricular fibrillation (VF) episode, syncope, and family history of Brugada Syndrome (BrS) or unexplained sudden cardiac death were collected. Electrophysiological study and implantable cardioverter‐defibrillator (ICD) were performed. All patients included in this study were followed up in the outpatient department every 6 months after baseline evaluation. Occurrences of syncope, VF, and sudden death were independently analyzed by two cardiologists. Results 45 (56.3%) patients were diagnosed with BrS. During a mean follow‐up of 7.9 ± 3.6 years, six patients had experienced documented VF/sudden cardiac death (SCD) or recurrent syncope. Two patients experienced episodes of syncope more than once. Two patients experienced onset of electrical storm with a total of 11 episodes of VF. There were 50% of these events occurring in fever status. One of patient with BrS died of SCD. Conclusion There was a very low prevalence of Brugada syndrome in southern Chinese population. The risk of arrhythmic events was low in asymptomatic patients. ICD was high effective in preventing SCD without adverse device outcome in long‐term follow‐up. Fever can lead to predispose to malignant arrhythmia, and aggressive treatment of febrile state in Brugada syndrome was recommended.
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Affiliation(s)
- Donghua Zhao
- First People's Hospital of Zhaoqing, Zhaoqing, China
| | - Bo Liang
- First People's Hospital of Zhaoqing, Zhaoqing, China
| | - Jian Peng
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Liangyu Tang
- First People's Hospital of Zhaoqing, Zhaoqing, China
| | - Rongbin Su
- First People's Hospital of Zhaoqing, Zhaoqing, China
| | - Lingli Luo
- First People's Hospital of Zhaoqing, Zhaoqing, China
| | - Bin Deng
- First People's Hospital of Zhaoqing, Zhaoqing, China
| | - Shuyuan Wang
- First People's Hospital of Zhaoqing, Zhaoqing, China
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19
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Maglione TJ, Aboyme A, Ghosh BD, Bhatti S, Kostis WJ. Electrical storm in a febrile patient with Brugada syndrome and COVID-19 infection. HeartRhythm Case Rep 2020; 6:676-679. [PMID: 32837908 PMCID: PMC7366958 DOI: 10.1016/j.hrcr.2020.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Theodore J. Maglione
- Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Andrew Aboyme
- Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Bobby D. Ghosh
- Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Sabha Bhatti
- Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - William J. Kostis
- Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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20
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Dendramis G, Brugada P. Intensive care and anesthetic management of patients with Brugada syndrome and COVID-19 infection. Pacing Clin Electrophysiol 2020; 43:1184-1189. [PMID: 32815174 PMCID: PMC7461416 DOI: 10.1111/pace.14044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/04/2020] [Accepted: 08/16/2020] [Indexed: 01/19/2023]
Abstract
Coronavirus disease 2019 (COVID-19) spreads across the world, and the intensive care unit (ICU) community must prepare for the challenges associated with this pandemic viral infection. Rapid diagnosis, isolation, and intensive clinical management are very important for all patients with COVID-19, especially for those with cardiac diseases as Brugada syndrome (BrS). BrS is an arrhythmogenic disease reported to be one among the leading causes of sudden cardiac death. In these patients, episodes of lethal arrhythmias may be induced by several factors or situations, and for this reason management during ICU permanence or anesthesia must provide some precautions, avoiding factors that are known to have the potential to worsen the probability to induce arrhythmias. For ICU practitioners, management of acute respiratory failure, hemodynamics, and cardiovascular complications certainly are the key for the best treatment of these patients but to date specific data on supportive ICU care for these patients are lacking, and current recommendations are based on existing evidence from other viral infections and general intensive care management. We want to focus on some general rules, resulted from cases series and clinical practice, to be followed during the ICU management of patients with BrS and concomitant COVID-19 infection.
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Affiliation(s)
- Gregory Dendramis
- Division of CardiologyARNAS Ospedale Civico e BenfratelliPalermoItaly,Heart Rhythm Management CentreUZ Brussel‐VUBBrusselsBelgium
| | - Pedro Brugada
- Heart Rhythm Management CentreUZ Brussel‐VUBBrusselsBelgium
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21
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Dyer S, Mogni B, Gottlieb M. Electrical storm: A focused review for the emergency physician. Am J Emerg Med 2020; 38:1481-1487. [PMID: 32345562 DOI: 10.1016/j.ajem.2020.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/31/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Electrical storm is a dangerous condition presenting to the Emergency Department that requires rapid diagnosis and management. OBJECTIVE This article provides a review of the diagnosis and management of electrical storm for the emergency clinician. DISCUSSION Electrical storm is defined as ≥3 episodes of sustained ventricular tachycardia, ventricular fibrillation, or shocks from an implantable cardioverter defibrillator within 24 h. Patients may present with a wide array of symptoms. Initial evaluation should include an electrocardiogram with a rhythm strip and continuous cardiac monitoring, a medication history, assessment of hemodynamic stability, and identification of potential triggers. Management includes an antiarrhythmic and a beta blocker. Refractory patients may benefit from double-sequential defibrillation or more invasive procedures such as intra-aortic balloon pumps, catheter ablation and extracorporeal membrane oxygenation for critically ill patients. These patients will typically require admission to an intensive care unit. CONCLUSION Electrical storm is a condition associated with significant morbidity and mortality. It is important for clinicians to be aware of the current evidence regarding the evaluation and management of these patients.
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Affiliation(s)
- Sean Dyer
- Department of Emergency Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, United States of America.
| | - Benjamin Mogni
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America
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22
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Sun XR, Liu T, Liu XP. Type 1 Brugada phenotype induced by cardiac iron overload after blood transfusion. HeartRhythm Case Rep 2020; 6:187-190. [PMID: 32322493 PMCID: PMC7156983 DOI: 10.1016/j.hrcr.2019.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Xue-Rong Sun
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Tong Liu
- Department of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xing-Peng Liu
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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23
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Kistamás K, Veress R, Horváth B, Bányász T, Nánási PP, Eisner DA. Calcium Handling Defects and Cardiac Arrhythmia Syndromes. Front Pharmacol 2020; 11:72. [PMID: 32161540 PMCID: PMC7052815 DOI: 10.3389/fphar.2020.00072] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/24/2020] [Indexed: 12/13/2022] Open
Abstract
Calcium ions (Ca2+) play a major role in the cardiac excitation-contraction coupling. Intracellular Ca2+ concentration increases during systole and falls in diastole thereby determining cardiac contraction and relaxation. Normal cardiac function also requires perfect organization of the ion currents at the cellular level to drive action potentials and to maintain action potential propagation and electrical homogeneity at the tissue level. Any imbalance in Ca2+ homeostasis of a cardiac myocyte can lead to electrical disturbances. This review aims to discuss cardiac physiology and pathophysiology from the elementary membrane processes that can cause the electrical instability of the ventricular myocytes through intracellular Ca2+ handling maladies to inherited and acquired arrhythmias. Finally, the paper will discuss the current therapeutic approaches targeting cardiac arrhythmias.
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Affiliation(s)
- Kornél Kistamás
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
| | - Roland Veress
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Balázs Horváth
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tamás Bányász
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Péter P Nánási
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Department of Dental Physiology, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
| | - David A Eisner
- Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
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24
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Li KHC, Lee S, Yin C, Liu T, Ngarmukos T, Conte G, Yan GX, Sy RW, Letsas KP, Tse G. Brugada syndrome: A comprehensive review of pathophysiological mechanisms and risk stratification strategies. IJC HEART & VASCULATURE 2020; 26:100468. [PMID: 31993492 PMCID: PMC6974766 DOI: 10.1016/j.ijcha.2020.100468] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 01/01/2020] [Accepted: 01/02/2020] [Indexed: 12/17/2022]
Abstract
Brugada syndrome (BrS) is an inherited ion channel channelopathy predisposing to ventricular arrhythmias and sudden cardiac death. Originally believed to be predominantly associated with mutations in SCN5A encoding for the cardiac sodium channel, mutations of 18 genes other than SCN5A have been implicated in the pathogenesis of BrS to date. Diagnosis is based on the presence of a spontaneous or drug-induced coved-type ST segment elevation. The predominant electrophysiological mechanism underlying BrS remains disputed, commonly revolving around the three main hypotheses based on abnormal repolarization, depolarization or current-load match. Evidence from computational modelling, pre-clinical and clinical studies illustrates that molecular abnormalities found in BrS lead to alterations in excitation wavelength (λ), which ultimately elevates arrhythmic risk. A major challenge for clinicians in managing this condition is the difficulty in predicting the subset of patients who will suffer from life-threatening ventricular arrhythmic events. Several repolarization risk markers have been used thus far, but these neglect the contributions of conduction abnormalities in the form of slowing and dispersion. Indices incorporating both repolarization and conduction based on the concept of λ have recently been proposed. These may have better predictive values than the existing markers. Current treatment options include pharmacological therapy to reduce the occurrence of arrhythmic events or to abort these episodes, and interventions such as implantable cardioverter-defibrillator insertion or radiofrequency ablation of abnormal arrhythmic substrate.
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Affiliation(s)
- Ka Hou Christien Li
- Faculty of Medicine, Newcastle University, Newcastle, United Kingdom.,Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Hong Kong, SAR, PR China
| | - Sharen Lee
- Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Hong Kong, SAR, PR China
| | - Chengye Yin
- School of Biological and Chemical Sciences, Queen Mary University of London, London, United Kingdom
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, PR China
| | - Tachapong Ngarmukos
- Department of Medicine Faculty of Medicine Ramathibodi Hospital Mahidol University, Bangkok, Thailand
| | - Giulio Conte
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Gan-Xin Yan
- Lankenau Institute for Medical Research and Lankenau Medical Center, Wynnewood, PA, USA
| | - Raymond W Sy
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - Konstantinos P Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, PR China.,Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
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Kushner J, Ferrer X, Marx SO. Roles and Regulation of Voltage-gated Calcium Channels in Arrhythmias. J Innov Card Rhythm Manag 2019; 10:3874-3880. [PMID: 32494407 PMCID: PMC7252866 DOI: 10.19102/icrm.2019.101006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/04/2019] [Indexed: 12/25/2022] Open
Abstract
Calcium flowing through voltage-dependent calcium channels into cardiomyocytes mediates excitation–contraction coupling, controls action-potential duration and automaticity in nodal cells, and regulates gene expression. Proper surface targeting and basal and hormonal regulation of calcium channels are vital for normal cardiac physiology. In this review, we discuss the roles of voltage-gated calcium channels in the heart and the mechanisms by which these channels are regulated by physiological signaling pathways in health and disease.
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Affiliation(s)
- Jared Kushner
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Xavier Ferrer
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Steven O Marx
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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26
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Ortmans S, Daval C, Aguilar M, Compagno P, Cadrin-Tourigny J, Dyrda K, Rivard L, Tadros R. Pharmacotherapy in inherited and acquired ventricular arrhythmia in structurally normal adult hearts. Expert Opin Pharmacother 2019; 20:2101-2114. [DOI: 10.1080/14656566.2019.1669561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Staniel Ortmans
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Charline Daval
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Martin Aguilar
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Electrophysiology service, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Pablo Compagno
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Julia Cadrin-Tourigny
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Cardiovascular Genetics Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Katia Dyrda
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Lena Rivard
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Electrophysiology service, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Rafik Tadros
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Cardiovascular Genetics Center, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Physiology and Pharmacology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
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27
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Marinković MM, Mujović NM, Potpara TS. Clinical approach to the patient with Brugada Syndrome: risk stratification and optimal management. Panminerva Med 2019; 61:473-485. [PMID: 31508925 DOI: 10.23736/s0031-0808.19.03736-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Brugada Syndrome (BrS) is an inherited cardiac ion channel disorder associated with increased risk of ventricular arrhythmias and mortality. Diagnosis is based on a characteristic electrocardiographic (ECG) pattern of coved type ST-segment elevation >2 mm followed by a negative T-wave in ≥1 of the right precordial leads V1 to V3. Since the first description of BrS, the definition of disease and underlying pathophysiological mechanisms have been significantly improved in recent years. Also, significant progress has been made in the field of genetic testing in these patients. Still, there are several open questions regarding the management and outcome of these patients. There is more information about patients who would need an implantable cardiac defibrillator for the primary prevention of sudden cardiac death (that is, those with spontaneous Type I Brugada ECG pattern and arrhythmia-related syncope), but currently published data concerning asymptomatic patients with Brugada ECG pattern and other less-well defined presentations are conflicting. Whereas the role of cardiac defibrillator in patients with Brugada Syndrome is clear, optimal use of catheter ablation and antiarrhythmic drug therapy needs to be further investigated. In this review, we summarize current evidence and contemporary management of patients with BrS.
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Affiliation(s)
| | - Nebojša M Mujović
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tatjana S Potpara
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia - .,School of Medicine, University of Belgrade, Belgrade, Serbia
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Romero J, Li DL, Avendano R, Diaz JC, Tung R, Di Biase L. Brugada Syndrome: Progress in Genetics, Risk Stratification and Management. Arrhythm Electrophysiol Rev 2019; 8:19-27. [PMID: 30918663 PMCID: PMC6434506 DOI: 10.15420/aer.2018.66.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Brugada syndrome (BrS) is one of the most common causes of sudden cardiac death in normal structural heart individuals. First characterised in 1992, the global prevalence of BrS is unclear, with estimates placing it at around 0.05% and presenting most frequently in southeast Asian countries. This review aims to summarise the development in the understanding of BrS and, importantly, progress in its management, underpinned by knowledge regarding its genetics and molecular mechanisms. It also provides update on risk stratification and promising new therapies for BrS, including epicardial ablation. Future studies are required to increase understanding of the pathogenesis of this disease and to guide clinical practice.
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Affiliation(s)
- Jorge Romero
- Montefiore Medical Center, Albert Einstein College of Medicine Bronx, NY, US
| | - Dan L Li
- Montefiore Medical Center, Albert Einstein College of Medicine Bronx, NY, US.,Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center Nashville, TN, US
| | - Ricardo Avendano
- Montefiore Medical Center, Albert Einstein College of Medicine Bronx, NY, US.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine New Haven, CT, US
| | - Juan Carlos Diaz
- Montefiore Medical Center, Albert Einstein College of Medicine Bronx, NY, US
| | - Roderick Tung
- University of Chicago, School of Medicine Chicago, IL, US
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine Bronx, NY, US
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30
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Malhi N, Cheung CC, Deif B, Roberts JD, Gula LJ, Green MS, Pang B, Sultan O, Konieczny KM, Angaran P, Dorian P, Lashevsky I, Healey JS, Alak A, Tadros R, Andorin A, Steinberg C, Ayala-Paredes F, Simpson CS, Atallah J, Krahn AD. Challenge and Impact of Quinidine Access in Sudden Death Syndromes. JACC Clin Electrophysiol 2019; 5:376-382. [DOI: 10.1016/j.jacep.2018.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/11/2018] [Accepted: 10/15/2018] [Indexed: 11/24/2022]
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31
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Belenkov YN, Snezhitskiy VA, Gizatulina TP, Shpak NV, Kuznetsov VA, Martyanova LU, Ardashev AV. [Not Available]. KARDIOLOGIIA 2018; 58:41-52. [PMID: 30625077 DOI: 10.18087/cardio.2018.11.10196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 11/24/2018] [Indexed: 06/09/2023]
Abstract
This review includes main positions of the revision of diagnostic criteria of "J-wave syndromes in the J-Wave Syndromes Expert Consensus Conference Report: Emerging Concepts and Gaps in Knowledge" (2016). The article, systematized according to the sections of the above-mentioned document, outlines the questions of terminology, new criteria for diagnosis of the Brugada syndrome (BrS) and early repolarization syndrome (ERS). The section devoted to ERS on the issues of new terminology and standardization of measurements, is supplemented with material from the Consensus Paper - The Early Repolarization Pattern (2015). The article also presents the issues of differential diagnosis in BrS, presents modulating factors, defines acquired Brugada-pattern and Brugada phenocopies. The similarities and differences between BrS and ERS are presented in a comparative aspect.
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Affiliation(s)
- Yu N Belenkov
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University).
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Espinosa Á, Ripollés-Melchor J, Brugada R, Campuzano Ó, Sarquella-Brugada G, Abad-Motos A, Zaballos-García M, Abad-Torrent A, Prieto-Gundin A, Brugada J. Brugada Syndrome: anesthetic considerations and management algorithm. Minerva Anestesiol 2018; 85:173-188. [PMID: 30394071 DOI: 10.23736/s0375-9393.18.13170-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Brugada Syndrome is characterized by arrhythmogenic risk that may be exacerbated by different metabolic and pharmacological factors. Since its first description, knowledge of this syndrome and its detection by physicians belonging to different specialties have gradually increased. The risk of arrhythmias is well known to increase in the postoperative period, and this risk is particularly accentuated in patients with Brugada Syndrome. The purpose of this review is to analyze the relationship between this syndrome and anesthesia; establish recommendations for the safe management of these patients in the surgical setting; and update the relevant concepts regarding the safety of drug administration in individuals with Brugada Syndrome.
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Affiliation(s)
- Ángel Espinosa
- Department of Cardiothoracic Anesthesia, Mohammed Bin Khalifa Bin Salman Al Khalifa Cardiac Center, Royal Medical Services, Awali, Bahrain.,Evidence Anesthesia Review Group (EAR), Department of Pharmacology, Faculty of Medicine of Complutense University of Madrid, Madrid, Spain
| | - Javier Ripollés-Melchor
- Evidence Anesthesia Review Group (EAR), Department of Pharmacology, Faculty of Medicine of Complutense University of Madrid, Madrid, Spain - .,Department of Anesthesiology and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.,Madrid Complutense University, Madrid, Spain.,Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain
| | - Ramón Brugada
- Cardiovascular Genetics Center, Girona Biomedical Research Institute (IDIBGI), University of Girona, Girona, Spain.,Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.,Cardiovascular Diseases Network Biomedical Research Center (CIBERCV), Madrid, Spain.,Department of Cardiology, Josep Trueta Hospital, Girona, Spain
| | - Óscar Campuzano
- Cardiovascular Genetics Center, Girona Biomedical Research Institute (IDIBGI), University of Girona, Girona, Spain.,Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.,Cardiovascular Diseases Network Biomedical Research Center (CIBERCV), Madrid, Spain
| | - Georgia Sarquella-Brugada
- Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.,Unit of Pediatric Arrhythmia, Department of Cardiology, Sant Joan de Déu Hospital, Barcelona, Spain.,Section of Arrhythmia, Department of Cardiology, Clinic Hospital, University of Barcelona, Barcelona, Spain
| | - Ane Abad-Motos
- Department of Anesthesiology and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.,Madrid Complutense University, Madrid, Spain.,Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain
| | - Matilde Zaballos-García
- Department of Anesthesiology, Gregorio Marañón University General Hospital, Madrid, Spain.,Clinical Toxicology, Madrid Complutense University, Madrid, Spain
| | - Ana Abad-Torrent
- Department of Anesthesiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alejandra Prieto-Gundin
- Department of Pediatric Anesthesiology, Sant Joan de Déu Hospital, Barcelona Children's Hospital, Barcelona, Spain
| | - Josep Brugada
- Unit of Pediatric Arrhythmia, Department of Cardiology, Sant Joan de Déu Hospital, Barcelona, Spain.,Section of Arrhythmia, Department of Cardiology, Clinic Hospital, University of Barcelona, Barcelona, Spain
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Di Diego JM, Antzelevitch C. J wave syndromes as a cause of malignant cardiac arrhythmias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:684-699. [PMID: 29870068 DOI: 10.1111/pace.13408] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/05/2018] [Indexed: 12/19/2022]
Abstract
The J wave syndromes, including the Brugada (BrS) and early repolarization (ERS) syndromes, are characterized by the manifestation of prominent J waves in the electrocardiogram appearing as an ST segment elevation and the development of life-threatening cardiac arrhythmias. BrS and ERS differ with respect to the magnitude and lead location of abnormal J waves and are thought to represent a continuous spectrum of phenotypic expression termed J wave syndromes. Despite over 25 years of intensive research, risk stratification and the approach to therapy of these two inherited cardiac arrhythmia syndromes are still rapidly evolving. Our objective in this review is to provide an integrated synopsis of the clinical characteristics, risk stratifiers, as well as the molecular, ionic, cellular, and genetic mechanisms underlying these two syndromes that have captured the interest and attention of the cardiology community over the past two decades.
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Affiliation(s)
| | - Charles Antzelevitch
- Lankenau Institute for Medical Research, Wynnewood, PA, USA.,Lankenau Heart Institute, Wynnewood, PA, USA.,Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
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34
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Levy D, Bigham C, Tomlinson D. Anaesthesia for patients with hereditary arrhythmias part I: Brugada syndrome. BJA Educ 2018; 18:159-165. [PMID: 33456827 DOI: 10.1016/j.bjae.2018.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2018] [Indexed: 12/23/2022] Open
Affiliation(s)
- D Levy
- Torbay Hospital, Torquay, UK
| | - C Bigham
- Derriford Hospital, Plymouth, UK
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Abstract
INTRODUCTION Brugada syndrome (BrS) is an inherited cardiac arrhythmia syndrome characterized by ST-segment elevation in right precordial ECG leads and associated with sudden cardiac death in young adults. The ECG manifestations of BrS are often concealed but can be unmasked by sodium channel blockers and fever. Areas covered: Implantation of a cardioverter defibrillator (ICD) is first-line therapy for BrS patients presenting with prior cardiac arrest or documented VT. A pharmacological approach to therapy is recommended in cases of electrical storm, as an adjunct to ICD and as preventative therapy. The goal of pharmacological therapy is to produce an inward shift to counter the genetically-induced outward shift of ion channel current flowing during the early phases of the ventricular epicardial action potential. This is accomplished by augmentation of ICa using □□adrenergic agents or phosphodiesterase III inhibitors or via inhibition of Ito. Radiofrequency ablation of the right ventricular outward flow tract epicardium is effective in suppressing arrhythmogenesis in BrS patients experiencing frequent appropriate ICD-shocks. Expert commentary: Understanding of the pathophysiology and approach to therapy of BrS has advanced considerably in recent years, but there remains an urgent need for development of cardio-selective and ion-channel-specific Ito blockers for treatment of BrS.
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Affiliation(s)
- Mariana Argenziano
- a Cardiovascular Research , Lankenau Institute for Medical Research , Wynnewood , PA , USA
| | - Charles Antzelevitch
- a Cardiovascular Research , Lankenau Institute for Medical Research , Wynnewood , PA , USA.,b Cardiovascular Research , Lankenau Heart Institute , Wynnewood , PA , USA.,c Department of Medicine and Pharmacology and Experimental Therapeutics , Sidney Kimmel Medical College of Thomas Jefferson University , Philadelphia , PA , USA
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36
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Abstract
Brugada syndrome (BrS) is a cardiac disease caused by an inherited ion channelopathy associated with a propensity to develop ventricular fibrillation. Implantable cardioverter defibrillator implantation is recommended in BrS, based on the clinical presentation in the presence of diagnostic ECG criteria. Implantable cardioverter defibrillator implantation is not always indicated or sufficient in BrS, and is associated with a high device complication rate. Pharmacological therapy aimed at rebalancing the membrane action potential can prevent arrhythmogenesis in BrS. Quinidine, a class 1A antiarrhythmic drug with significant Ito blocking properties, is the most extensively used drug for the prevention of arrhythmias in BrS. The present review provides contemporary data gathered on all drugs effective in the therapy of BrS, and on ineffective or contraindicated antiarrhythmic drugs.
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Key Words
- Brugada syndrome,
- arrhythmia,
- bepridil,
- cilostazol,
- denopamine,
- disopyramide,
- isoproterenol,
- orciprenaline,
- pharmacology,
- quinidine,
- quinine
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Affiliation(s)
- Oholi Tovia Brodie
- University of Miami Miller School of Medicine Miami, USA.,Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Israel
| | - Yoav Michowitz
- Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Israel
| | - Bernard Belhassen
- Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Israel
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37
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Antzelevitch C, Viskin S. Should theophylline be added to the J wave syndrome therapeutic armamentarium? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 41:439-440. [PMID: 29148067 DOI: 10.1111/pace.13237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/18/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Charles Antzelevitch
- Lankenau Institute for Medical Research, Wynnewood, PA, USA.,Lankenau Heart Institute, Main Line Health System, Wynnewood, PA, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sami Viskin
- Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
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38
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Viskin S, Havakuk O, Antzelevitch C, Rosso R. Theophylline: The forgotten antiarrhythmic drug… now for malignant early repolarization. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 41:441-443. [PMID: 29148055 DOI: 10.1111/pace.13239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/22/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Sami Viskin
- Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
| | - Ofer Havakuk
- Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
| | | | - Raphael Rosso
- Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
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39
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Letsas KP, Asvestas D, Baranchuk A, Liu T, Georgopoulos S, Efremidis M, Korantzopoulos P, Bazoukis G, Tse G, Sideris A, Takagi M, Ehrlich JR. Prognosis, risk stratification, and management of asymptomatic individuals with Brugada syndrome: A systematic review. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:1332-1345. [PMID: 28994463 DOI: 10.1111/pace.13214] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 08/30/2017] [Accepted: 09/10/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Konstantinos P. Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology; Evangelismos General Hospital of Athens; Athens Greece
| | - Dimitrios Asvestas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology; Evangelismos General Hospital of Athens; Athens Greece
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University; Kingston General Hospital; Kingston Ontario Canada
| | - Tong Liu
- Department of Cardiology, Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin P.R. China
| | - Stamatis Georgopoulos
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology; Evangelismos General Hospital of Athens; Athens Greece
| | - Michael Efremidis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology; Evangelismos General Hospital of Athens; Athens Greece
| | | | - George Bazoukis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology; Evangelismos General Hospital of Athens; Athens Greece
| | - Gary Tse
- Department of Medicine and Therapeutics; Chinese University of Hong Kong; Hong Kong SAR P.R. China
- Li Ka Shing Institute of Health Sciences; Chinese University of Hong Kong; Hong Kong SAR P.R. China
| | - Antonios Sideris
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology; Evangelismos General Hospital of Athens; Athens Greece
| | - Masahiko Takagi
- Department of Cardiovascular Medicine; Osaka City University Graduate School of Medicine; Osaka Japan
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40
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Amara W, Bouallouche SA, Rezoug A, Hraiech AE, Iusuf A, Hammoudi N. [Epidemiology of early repolarization pattern in Maghreb]. Ann Cardiol Angeiol (Paris) 2017; 66:249-254. [PMID: 29050732 DOI: 10.1016/j.ancard.2017.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/12/2017] [Indexed: 06/07/2023]
Abstract
UNLABELLED An early repolarization variant (ERV) in inferolateral leads has recently been associated with vulnerability to ventricular fibrillation. These studies have been conducted in the occidental countries. The prevalence of ERV in the population of the Maghreb is unknown. The aim of this study was to evaluate the prevalence and risk factors of ERV in a young population from Algeria. METHODS We assessed the prevalence of ERV within a population of 441 healthy subjects (mean age 25 years) using 12-lead electrocardiography. ERV was stratified by three independent cardiologists according to the J-point elevation (≥0.1mV) in the inferior, apicolateral or both leads with QRS slurring or notching. RESULTS The inferolateral ERV pattern was present in 55 subjects (12.4%). A malign ERV (>2mm) was present in 5 subjects (9% of ER) and ER in inferior and lateral leads in 40% of ER. An ERV pattern was more frequently associated with young age, male, bradycardia and T wave in V1 lead. CONCLUSION An ERV is a common finding in a healthy Algerian young population. This prevalence seems to be more important than other studies due to young age and not to a racial difference. Our population were more at risk that other studies, and we found more T waves in V1 lead in this people, due to an ethnic particularities or a phenotypic association with the Brugada syndrome.
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Affiliation(s)
- W Amara
- Unité de rythmologie, GHI Le Raincy-Montfermeil, 10, rue du Gl Leclercq, 93370 Montfermeil, France.
| | - S A Bouallouche
- Unité de rythmologie, GHI Le Raincy-Montfermeil, 10, rue du Gl Leclercq, 93370 Montfermeil, France
| | - A Rezoug
- Hôpital Maouche-Mohand-Amokrane, 16000 Alger, Algérie
| | - A El Hraiech
- Hopital universitaire Fattouma-Bourguiba, avenue Farhat-Hached, 5000 Monastir, Tunisie
| | - A Iusuf
- Centre hospitalier Marne-La-Vallée, 2-4, cours de la Gondoire, 77600 Jossigny, France
| | - N Hammoudi
- Hôpital Maouche-Mohand-Amokrane, 16000 Alger, Algérie
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41
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Abstract
Brugada syndrome (BrS) is one of the commonest inherited primary arrhythmia syndromes typically presenting with arrhythmic syncope or sudden cardiac death (SCD) due to polymorphic ventricular tachycardia and ventricular fibrillation precipitated by vagotonia or fever in apparently healthy adults, less frequently in children. The prevalence of the syndrome (0.01%-0.3%) varies among regions and ethnicities, being the highest in Southeast Asia. BrS is diagnosed by the "coved type" ST-segment elevation≥2mm followed by a negative T-wave in ≥1 of the right precordial leads V1-V2. The typical electrocardiogram in BrS is often concealed by fluctuations between normal, non-diagnostic and diagnostic ST-segment pattern in the same patient, thus hindering the diagnosis. Presently, the majority of BrS patients is incidentally diagnosed, and may remain asymptomatic for their lifetime. However, BrS is responsible for 4-12% of all SCDs and for ~20% of SCDs in patients with structurally normal hearts. Arrhythmic risk is the highest in SCD survivors and in patients with spontaneous BrS electrocardiogram and arrhythmic syncope, but risk stratification for SCD in asymptomatic subjects has not yet been fully defined. Recent achievements have expanded our understanding of the genetics and electrophysiological mechanisms underlying BrS, while radiofrequency catheter ablation may be an effective new approach to treat ventricular tachyarrhythmias in BrS patients with arrhythmic storms. The present review summarizes our contemporary understanding and recent advances in the inheritance, pathophysiology, clinical assessment and treatment of BrS patients.
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Affiliation(s)
- Marija M Polovina
- School of Medicine, Belgrade University, Belgrade, Serbia; Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Bojan Banko
- Centre for Radiology and MRI, Clinical Centre of Serbia, Belgrade, Serbia
| | - Gregory Y H Lip
- School of Medicine, Belgrade University, Belgrade, Serbia; University of Birmingham, Institute of Cardiovascular Science, City Hospital, Birmingham, United Kingdom
| | - Tatjana S Potpara
- School of Medicine, Belgrade University, Belgrade, Serbia; Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia.
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Dendramis G, Paleologo C, Sgarito G, Giordano U, Verlato R, Baranchuk A, Brugada P. Anesthetic and Perioperative Management of Patients With Brugada Syndrome. Am J Cardiol 2017; 120:1031-1036. [PMID: 28739038 DOI: 10.1016/j.amjcard.2017.06.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 05/30/2017] [Accepted: 06/15/2017] [Indexed: 10/19/2022]
Abstract
Brugada syndrome (BrS) is an arrhythmogenic disease reported to be one among the leading causes of cardiac death in subjects under the age of 40 years. In these patients, episodes of lethal arrhythmias may be induced by several factors or situations, and for this reason, management during anesthesia and surgery must provide some precautions and drugs restrictions. To date, it is difficult to formulate guidelines for anesthetic management of patients with BrS because of the absence of prospective studies, and there is not a definite recommendation for neither general nor regional anesthesia, and there are no large studies in merit. For this reason, in the anesthesia management of patients with BrS, the decision of using each drug must be made after careful consideration and always in controlled conditions, avoiding other factors that are known to have the potential to induce arrhythmias and with a close cooperation between anesthetists and cardiologists, which is essential before and after surgery. In conclusion, given the absence of large studies in literature, we want to focus on some general rules, which resulted from case series and clinical practice, to be followed during the perioperative and anesthetic management of patients with BrS.
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Shenthar J, Chakali SS, Acharya D, Parvez J, Banavalikar B. Oral quinine sulfate for the treatment of electrical storm and prevention of recurrent shocks in Brugada syndrome after failed cilostazol therapy. HeartRhythm Case Rep 2017; 3:470-474. [PMID: 29062700 PMCID: PMC5643860 DOI: 10.1016/j.hrcr.2017.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jayaprakash Shenthar
- Electrophysiology Unit, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Siva Sankara Chakali
- Electrophysiology Unit, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Debashish Acharya
- Electrophysiology Unit, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Javed Parvez
- Electrophysiology Unit, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - Bharatraj Banavalikar
- Electrophysiology Unit, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
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Turker I, Ai T, Itoh H, Horie M. Drug-induced fatal arrhythmias: Acquired long QT and Brugada syndromes. Pharmacol Ther 2017; 176:48-59. [PMID: 28527921 DOI: 10.1016/j.pharmthera.2017.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Since the early 1990s, the concept of primary "inherited" arrhythmia syndromes or ion channelopathies has evolved rapidly as a result of revolutionary progresses made in molecular genetics. Alterations in genes coding for membrane proteins such as ion channels or their associated proteins responsible for the generation of cardiac action potentials (AP) have been shown to cause specific malfunctions which eventually lead to cardiac arrhythmias. These arrhythmic disorders include congenital long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, short QT syndrome, progressive cardiac conduction disease, etc. Among these, long QT and Brugada syndromes are the most extensively studied, and drugs cause a phenocopy of these two diseases. To date, more than 10 different genes have been reported to be responsible for each syndrome. More recently, it was recognized that long QT syndrome can be latent, even in the presence of an unequivocally pathogenic mutation (silent mutation carrier). Co-existence of other pathological conditions in these silent mutation carriers may trigger a malignant form of ventricular arrhythmia, the so called torsade de pointes (TdP) that is most commonly brought about by drugs. In analogy to the drug-induced long QT syndrome, Brugada type 1 ECG can also be induced or unmasked by a wide variety of drugs and pathological conditions; so physicians may encounter patients with a latent form of Brugada syndrome. Of particular note, Brugada syndrome is frequently associated with atrial fibrillation whose therapeutic agents such as Vaughan Williams class IC drugs can unmask the dormant and asymptomatic Brugada syndrome. This review describes two types of drug-induced arrhythmias: the long QT and Brugada syndromes.
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Affiliation(s)
- Isik Turker
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Tomohiko Ai
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Clinical Laboratory Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Hideki Itoh
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Minoru Horie
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan.
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Poli S, Toniolo M, Maiani M, Zanuttini D, Rebellato L, Vendramin I, Dametto E, Bernardi G, Bassi F, Napolitano C, Livi U, Proclemer A. Management of untreatable ventricular arrhythmias during pharmacologic challenges with sodium channel blockers for suspected Brugada syndrome. Europace 2017; 20:234-242. [DOI: 10.1093/europace/eux092] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 03/15/2017] [Indexed: 01/21/2023] Open
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Antzelevitch C, Yan GX, Ackerman MJ, Borggrefe M, Corrado D, Guo J, Gussak I, Hasdemir C, Horie M, Huikuri H, Ma C, Morita H, Nam GB, Sacher F, Shimizu W, Viskin S, Wilde AA. J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge. Europace 2017; 19:665-694. [PMID: 28431071 PMCID: PMC5834028 DOI: 10.1093/europace/euw235] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
| | - Gan-Xin Yan
- Lankenau Medical Center, Wynnewood, Pennsylvania
| | - Michael J. Ackerman
- Departments of Cardiovascular Diseases, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester,Minnesota
| | - Martin Borggrefe
- 1st Department of Medicine–Cardiology, University Medical Centre Mannheim, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Jihong Guo
- Division of Cardiology, Peking University of People's Hospital, Beijing, China
| | - Ihor Gussak
- Rutgers University, New Brunswick, New Jersey
| | - Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | - Minoru Horie
- Shiga University of Medical Sciences, Ohtsu, Shiga, Japan
| | - Heikki Huikuri
- Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital, and University of Oulu, Oulu, Finland
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Gi-Byoung Nam
- Heart Institute, Asan Medical Center, and Department of Internal Medicine, University of Ulsan College of Medicine Seoul, Seoul, Korea
| | - Frederic Sacher
- Bordeaux University Hospital, LIRYC Institute/INSERM 1045, Bordeaux, France
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Sami Viskin
- Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arthur A.M. Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands and Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Kingdom of Saudi Arabia
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Abstract
It is almost a quarter of century that a pioneering work of 2 researchers named Brugada brought the entire scientific community to understanding the molecular, clinical, and electrophysiological aspects of a distinctive syndrome. It affects mainly young adults with syncope and/or sudden cardiac death caused by polymorphic ventricular tachycardia or ventricular fibrillation in the absence of any sign of cardiac degeneration or alteration. Although the involvement of the epicardial layer of the right ventricular outflow tract, and the requirement of pharmacologic challenge for unveiling concealed forms, have been fully characterized, many areas of uncertainties remain to be elucidated, such as the unpredictable usefulness of programmed ventricular stimulation, the role of radiofrequency catheter ablation for reducing ST-segment elevation, and the value of risk stratification in patients diagnosed with upper displacement of right precordial leads. How much Brugada syndrome is an intense field of research is witnessed by 4 different consensus committees that took place in a relatively short period of time considering the recent discovery of this intricate arrhythmogenic disease. The main focus of this review is to describe the milestones in Brugada syndrome from its first phenotypic and genotypic appraisals to recent achievements in electrical therapies proposed for the management of this fascinating rhythm disturbance that, despite new diagnostic and therapeutic learnings, still predisposes to sudden cardiac death.
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Affiliation(s)
- Antonio Curcio
- Division of Cardiology, Department of Medical and Surgical Sciences, University Magna Graecia, Campus di Germaneto
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Letsas KP, Georgopoulos S, Vlachos K, Karamichalakis N, Liatakis I, Korantzopoulos P, Liu T, Efremidis M, Sideris A. Brugada Syndrome:Risk Stratification And Management. J Atr Fibrillation 2016; 9:1413. [PMID: 27909531 DOI: 10.4022/jafib.1413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/06/2016] [Accepted: 06/06/2016] [Indexed: 01/14/2023]
Abstract
The Brugada syndrome (BrS) is an arrhythmogenic disease associated with an increased risk of ventricular fibrillation and sudden cardiac death. The risk stratification and management of BrS patients, particularly of asymptomatic ones, still remains challenging. A previous history of aborted sudden cardiac death or arrhythmic syncope in the presence of spontaneous type 1 ECG pattern of BrS phenotype appear to be the most reliable predictors of future arrhythmic events. Several other ECG parameters have been proposed for risk stratification. Among these ECG markers, QRS-fragmentation appears very promising. Although the value of electrophysiological study still remains controversial, it appears to add important information on risk stratification, particularly when incorporated in multiparametric scores in combination with other known risk factors. The present review article provides an update on the pathophysiology, risk stratification and management of patients with BrS.
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Affiliation(s)
- Konstantinos P Letsas
- Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece
| | - Stamatis Georgopoulos
- Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece
| | - Konstantinos Vlachos
- Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece
| | | | - Ioannis Liatakis
- Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece
| | | | - Tong Liu
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, People's Republic of China
| | - Michael Efremidis
- Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece
| | - Antonios Sideris
- Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece
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Sieira J, Brugada P. Management of Brugada Syndrome 2016: Should All High Risk Patients Receive an ICD? All High-Risk Patients Should Receive an Implantable Cardiac Defibrillator. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004195. [PMID: 27906652 DOI: 10.1161/circep.116.004195] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/26/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Juan Sieira
- From the Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
| | - Pedro Brugada
- From the Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium.
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Konishi S, Minamiguchi H, Okuyama Y, Sakata Y. Sodium channel blockade unmasked Brugada electrocardiographic pattern in a patient with complete right bundle branch block and early repolarization in the lateral leads. Clin Case Rep 2016; 4:1061-1064. [PMID: 27830074 PMCID: PMC5093164 DOI: 10.1002/ccr3.636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 05/24/2016] [Accepted: 06/16/2016] [Indexed: 11/26/2022] Open
Abstract
Early repolarization syndrome (ERS) and Brugada syndrome (BrS) share many electrocardiographic and clinical features, and recently have been collectively grouped as J wave syndrome. However, the effects of sodium channel blockers on the J waves differ greatly between ERS and BrS.
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Affiliation(s)
- Shozo Konishi
- Department of Cardiovascular Medicine Osaka Graduate School of Medicine Suita Japan
| | - Hitoshi Minamiguchi
- Department of Cardiovascular Medicine Osaka Graduate School of Medicine Suita Japan
| | - Yuji Okuyama
- Department of Cardiovascular Medicine Osaka Graduate School of Medicine Suita Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine Osaka Graduate School of Medicine Suita Japan
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