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The Importance of Class‐I Antiarrhythmic Drug Test in the Evaluation of Patients with Syncope: Unmasking Brugada Syndrome
Author(s) -
ROOS MARKUS,
SARKOZY ANDREA,
BRODBECK JEANNETTE,
HENKENS STEFAN,
CHIERCHIA GIANBATTISTA,
ASMUNDIS CARLO DE,
CAPULZINI LUCIO,
MÜLLERBURRI STEPHAN ANDREAS,
YAKAZI YOSHI,
BRUGADA PEDRO
Publication year - 2012
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2011.02193.x
Subject(s) - medicine , brugada syndrome , syncope (phonology) , cardiology , ventricular tachycardia
Syncope in Brugada Syndrome. Introduction: The Brugada syndrome (BrS) can first present with syncope. Class‐I antiarrhythmic drug (AAD) test is used to unmask the diagnostic coved‐type ECG pattern in case it is not spontaneously present. The aim of the study was to analyze patients with BrS presenting with syncope as first manifestation and compare patients with syncope and a spontaneous coved‐type ECG to patients with syncope in whom a class‐I AAD test unmasked the disease.Methods and Results: Fifty‐eight of 157 probands (36.9%) had syncope as first manifestation of the disease. Twenty‐six patients (44.8%, group A) showed a spontaneous coved‐type ECG diagnostic for BrS at first presentation. In 32 patients (55.2%, group B) without spontaneous coved‐type ECG pattern at first presentation (36% normal ECGs and 19% type‐II ECG pattern), a class‐I AAD test unmasked the disease. Twenty‐one patients of group A and 29 patients of group B underwent implantable cardioverter defibrillator (ICD) implantation. The mean follow up as 9.7 ± 55.7 month. Four patients in group A (15.4%) and 3 patients (9.3%) in group B had appropriate ICD shock delivery due to ventricular fibrillation or ventricular tachycardia (P = NS).Conclusion: One of 3 patients with BrS presents first with syncope. More than one‐third of these patients have a normal ECG at investigation for syncope and the correct diagnosis would have been missed without a class‐I AAD test. Patients presenting with syncope are at similar risk irrespective of the presence of a spontaneous coved‐type ECG. (J Cardiovasc Electrophysiol, Vol. 23 p. 290‐295, March 2012.)