on September 20, 2004
Published online before print September 20, 2004, doi: 10.1161/01.CIR.0000143159.30585.90
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Submitted on January 25, 2004
From the Department of Cardiology, Tel-Aviv Sourasky Medical Center, and Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel. * To whom correspondence should be addressed. E-mail: bblhass{at}tasmc.health.gov.il.
Background--Automatic implantable cardioverter-defibrillator therapy is considered the only effective treatment for high-risk patients with Brugada syndrome. Quinidine depresses Ito current, which may play an important role in the arrhythmogenesis of this disease. Methods and Results--The effects of quinidine bisulfate (mean dose, 1483±240 mg) on the prevention of inducible and spontaneous ventricular fibrillation (VF) were prospectively evaluated in 25 patients (24 men, 1 woman; age, 19 to 80 years) with Brugada syndrome. There were 15 symptomatic patients (including 7 cardiac arrest survivors and 7 patients with unexplained syncope) and 10 asymptomatic patients. All 25 patients had inducible VF at baseline electrophysiological study. Quinidine prevented VF induction in 22 of the 25 patients (88%). After a follow-up period of 6 months to 22.2 years, all patients are alive. Nineteen patients were treated with quinidine for 6 to 219 months (mean±SD, 56±67 months). None had an arrhythmic event, although 2 had non-arrhythmia-related syncope. Administration of quinidine was associated with a 36% incidence of side effects that resolved after drug discontinuation. Conclusions--Quinidine effectively prevents VF induction in patients with Brugada syndrome. Our data suggest that quinidine also suppresses spontaneous arrhythmias and could prove to be a safe alternative to automatic implantable cardioverter-defibrillator therapy for a substantial proportion of patients with Brugada syndrome. Randomized studies comparing these two therapies seem warranted.
Revised on March 12, 2004
Accepted on May 20, 2004
Efficacy of Quinidine in High-Risk Patients With Brugada Syndrome
Bernard Belhassen MD*,
Key words: antiarrhythmic agents • electrophysiology • tachyarrhythmias
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