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Medical knowledge changes very fast. You may consider contacting us directly at the enclosed email before taking any decisions or making recommendations, or for the purpose to sent blood samples for genetic studies. ramon@brugada.orgThe following strategy is recommended at present: 1.- From each individual seen because of the diagnosis or suspicion of Brugada syndrome take a medical history with special attention to symptoms that may suggest arrhythmias like syncope, presyncope, dizziness, palpitations. Special attention must also be given to a family history of unexplained syncope, sudden death and unexplained traumatic deaths like car accidents that may result from loss of consciousness. Do not accept a diagnosis of the causes of sudden death or syncope unless proven. In 50% of the cases of sudden death in families with Brugada syndrome the cause of sudden death is Brugada syndrome, but in the other half the cause is a myocardial infarction or is unclear. 2.- Physical examination will usually be normal, but it should be carefully done to exclude any condition that may simulate Brugada syndrome. 3.- Record a 12-lead resting electrocardiogram and an electrocardiogram after the administration of either: a.- ajmaline 1mg/kg body weight iv in 5 minutes, or b.- flecainide 2 mg/Kg body weight iv in 10 minutes, or c.- procainamide, 10 mg/kg body weight iv in 10 min. These tests should be performed in an environment with facilities for CPR because in 0.5% of tests the patient may develop ventricular fibrillation. Ajmaline is the preferred drug because of the very short half-life. If necessary, consider approval of the test by your local ethical committee before performing it. A pharmacologic test is considered positive if an additional 1 mm ST segment elevation appears in leads V1, V2 and V3. The ST segment elevation is measured 0.08 s after the J wave. 4.- All positive individuals should undergo programmed ventricular stimulation to assess inducibility of ventricular arrhythmias and to measure the conduction intervals (the H-V interval is frequently prolonged in Brugada syndrome). Programmed ventricular stimulation should at least include two different pacing cycle lengths from the right ventricular apex and at least two ventricular premature beats. |