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(Circulation. 2005;112:279-292.)
© 2005 American Heart Association, Inc.

Controversies in Cardiovascular Medicine

Should patients with an asymptomatic Brugada electrocardiogram undergo pharmacological and electrophysiological testing?

Pedro Brugada, MD, PhD, FESC; Ramon Brugada, MD; Josep Brugada, MD, PhD

From the Cardiovascular Research and Teaching Institute, Aalst, Belgium (P.B.); the New York Heart Center, Syracuse, New York (R.B.); Thorax Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain (J.B.); Molecular Cardiology Laboratories IRCCS, Fondazione S Maugeri, Pavia, Italy (S.G.P., C.N.); and the Department of Cardiology, University of Pavia, Pavia, Italy (S.G.P.).

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Brugada syndrome presents in a certain number of patients as an inherited cardiac arrhythmia disorder caused by mutations in the cardiac sodium channel gene SCN5A. Carriers of the disease may develop a variety of cardiac arrhythmias, including supraventricular tachycardias, atrioventricular conduction defects or block, sick sinus syndrome with atrial standstill, and ventricular tachycardia and ventricular fibrillation. The disease is characterized by the lack of structural heart disease and an ECG with a characteristic coved-type ST-segment elevation in leads V₁, V₂, and V₃. Syncopal episodes and paroxysmal palpitations are the only symptoms attributable to the disease that may warn before (aborted) sudden arrhythmic death occurs. General agreement exists that an implantable cardioverter defibrillator must be given to patients with Brugada syndrome resuscitated from ventricular fibrillation. However, controversy exists on how to approach the individual with a Brugada-like ECG who has never developed ventricular fibrillation.

For the past 12 years, we have maintained a large database of individuals and patients with a characteristic Brugada-like ECG (all coved type). At the last follow-up (January 2004), we analyzed the status of 724 individuals of whom 547 (75%) had no previous cardiac arrest. A subgroup of 167 asymptomatic individuals was also identified who had no family history of sudden death or Brugada syndrome and were considered fortuitous, isolated cases. The abnormal ECG was identified during the investigation of syncope in 124 individuals, during routine ECG screening in 170 individuals, and during study of family members of patients with the syndrome in . . . [Full Text of this Article]

Silvia G. Priori, MD, PhD; Carlo Napolitano, MD, PhD

Pedro Brugada, MD, PhD, FESC; Ramon Brugada, MD; Josep Brugada, MD, PhD

Silvia G. Priori, MD, PhD; Carlo Napolitano, MD, PhD

Correspondence to Josep Brugada, MD, PhD, Thorax Institute, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain (e-mail jbrugada@clinic.ub.es), or Silvia G. Priori, MD, PhD, Molecular Cardiology Laboratories IRCCS, Fondazione S Maugeri, Via Ferrata 8, 27100 Pavia, Italy (e-mail spriori@fsm.it).

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