Document Detail


Flecainide test in Brugada syndrome: a reproducible but risky tool.
MedLine Citation:
PMID:  12687841     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The flecainide test is widely used in Brugada syndrome. However, its reproducibility and safety remain ill-defined. This study included 22 patients (18 men, mean age 34 years). Mutations in the SCN5A gene were found in eight patients. Two patients had aborted sudden cardiac death, 8 had syncope/presyncope, and 12 were asymptomatic. The ECG was diagnostic in 19 patients and suggestive in 3. At baseline, 21 of 22 patients underwent a flecainide test (2 mg/kg IV bolus over 10 minutes). In 21 of 21 patients the test was diagnostic or amplified the typical ECG pattern. At the end of drug infusion, sustained VT lasting 7-10 minutes developed in two patients. A second flecainide test was performed within 2 months in 20 patients. The test was not repeated in the two patients with prior development of VT. The flecainide test was diagnostic in 20 of 20 patients. Sustained VT occurred in one patient and recurrent VF in another. The reproducibility of the flecainide test was 100%. In 4 (18%) of 22 patients major VAs were documented after the end of flecainide infusion. VA occurred in 3 (43%) of 7 patients with, versus 1 (7%) 15 without SCN5A gene mutation (P < 0.05). No diagnostic ECG changes or arrhythmias developed in 25 control patients without structural heart disease who underwent the same study protocol. This study shows a high flecainide reproducibility, supporting its diagnostic value in Brugada syndrome. However, the occurrence of major VA, significantly higher in patients with documented SCN5A gene mutation, including in asymptomatic patients, mandates the performance under appropriate medical supervision. Whether a slower rate of drug infusion can lower the risk of VA induction, while maintaining the sensitivity of the test should be explored.
Authors:
Maurizio Gasparini; Silvia G Priori; Massimo Mantica; Carlo Napolitano; Paola Galimberti; Carlo Ceriotti; Stefano Simonini
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  26     ISSN:  0147-8389     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  2003 Jan 
Date Detail:
Created Date:  2003-04-11     Completed Date:  2003-07-03     Revised Date:  2011-07-22    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  338-41     Citation Subset:  IM    
Affiliation:
Cardiac Electrophysiology and Pacing Unit Humanitas Clinical Institute, Rozzano, Milan, Italy. maurizio.gasparini@humanitas.it
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Anti-Arrhythmia Agents / adverse effects,  diagnostic use*
Bundle-Branch Block / diagnosis*,  genetics,  physiopathology
Death, Sudden, Cardiac / etiology
Electrocardiography / drug effects*
Female
Flecainide / adverse effects,  diagnostic use*
Humans
Male
Middle Aged
Mutation
Reproducibility of Results
Risk Factors
Sodium Channels / genetics
Syncope
Syndrome
Tachycardia, Ventricular / chemically induced
Ventricular Fibrillation / physiopathology
Chemical
Reg. No./Substance:
0/Anti-Arrhythmia Agents; 0/Sodium Channels; 0/sodium channel protein type 5 subunit alpha; 54143-55-4/Flecainide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Enhancement of J-ST-segment elevation by the glucose and insulin test in Brugada syndrome.
Next Document:  Catheter ablation of ventricular tachycardia following myocardial infarction using three-dimensional...