Friday, June 29, 2018

Unmasking Brugada syndrome

Q:  27 year old male is admitted to ICU after he suddenly collapsed at basketball practice. He was revived quickly. He regained consciousness and is admitted to ICU. Patient's first cousin died of sudden cardiac death previously. Cardiology service is highly suspicious of Brugada syndrome but EKG does not follow the classic pattern of the syndrome. Which of the following drugs can be used as a  provocative test to unmask type 1 Brugada pattern in  patients who have clinical presentation suggestive but not diagnostic of Brugada syndrome?

A) Amiodarone 
B) Lopressor
C) Procainamide
D) Flecainide
E) Digoxin

Answer: D

Sodium channel blockers (flecainide, ajmaline, or procainamide) can transiently induce the  Brugada EKG pattern. As oral flecainide is easily available, it can be safely used to unmask Type 1 Brugada pattern in controlled enviroment such as ICU. Most institutions have protocol to carry out the "flecainide challenge test".



1. Gasparini M., Priori S.G., Mantica M., Napolitano C., Galimberti P., Ceriotti C. Flecainide test in Brugada syndrome: a reproducible but risky tool. Pacing Clin Electrophysiol. 2003 Jan;26(1 Pt 2):338–341 

2.. Dubner S., Azocar D., Gallino S., Cerantonio A.R., Muryan S., Medrano J. Single oral flecainide dose to unmask type 1 Brugada syndrome electrocardiographic pattern. Ann Noninvasive Electrocardiol. 2013 May;18(3):256–261

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