Inducible Ventricular Fibrillation in the Brugada Syndrome:

Two leading groups of investigators are reporting differing conclusions regarding the value of electrophysiologic studies (EPS) in the Brugada syndrome. First, Brugada et al.1 reported that EPS has excellent accuracy for predicting outcome in the Brugada syndrome. Soon thereafter, however, Priori et al.2 concluded quite the opposite. Based on a study of 86 patients with Brugada syndrome who underwent EPS, Priori et al.2 found that the test was not useful in identifying patients at risk for arrhythmic events. Finally, in this issue of the Journal, Brugada et al.3 reinforce their previous findings1 by reporting on more patients and a longer follow-up period, thus reaffirming that EPS effectively predicts outcome. When authorities of this scale reach opposing conclusions, statements such as “the discrepancies observed are due to differences in patient selection and EPS protocols” usually apply. Nevertheless, the clinician is left with so much uncertainty that a critical look at the evidence is warranted.