BRUGADA SYNDROME

Responsible for 60% of cases of idiopathic VF

50% have malignant arrhythmias
Epidemiology M>F; most common in SE Asia; usually presents age 30yrs
30% develop during febrile episode; 70% induced by meds (eg. Na blockers)
Untreated mortality 20% at 2yrs

Autosomal dominant; defect of Na channel

Aetiology
Structurally normal heart, no IHD

Long PR
Partial RBBB
ECG Findings STE in leads V1-3, with downsloping ST segments
TWI V1-3 or decreased wave amplitude
Short QT

Brugada pattern on ECG + at least one of: Syncopal episodes

VF
Diagnosis Polymorphic VT
Sudden cardiac death in relative <45yrs
ST elevation in family members

ICD implantation (if symptomatic or positive flecainide challenge)

Management
Avoid Ia and Ic, and Na channel blockers
 Effect: prolong conduction at AVN
Class ECG changes: prolonged PR
IV
Dihydropyridines: nifedipine, felodipine, amlodipine, nimodipine
Vasodilatation without negative inotrope, reflex tachycardia likely)
Calcium
Verapamil: 1mg IV increments
channel
Negative inotrope, may worsen CCF / cause HB
blockers
Diltiazem: SE as verapamil