Drug challenge in Brugada syndrome – Cardiology MCQ – Answer

Drug challenge in Brugada syndrome – Cardiology MCQ – Answer

Which of the following is not usually used as drug challenge to unmask the Brugada Type I ECG pattern? – Correct answer: d) Propranolol

Drug challenge is used when there is clinical suspicion in the form of syncope, agonal respiration and family history, but ECG does not show the classical type I Brugada syndrome ECG. Sodium channel blockers are used to unmask the ECG changes of the disease. Drug challenge should be cautiously done with continuous ECG monitoring and occurrence of QRS widening more than 130% of baseline, frequent ventricular ectopics or complex ventricular ectopy mandate discontinuation of drug infusion to prevent life threatening ventricular arrhythmias [1]. In case of prolonged cardiac arrest, advanced cardiopulmonary resuscitation (ECPR) with extra corporeal membrane oxygenator (ECMO) may be needed in refractory cases [2].

Intravenous ajmaline or flecainide can be used for the drug challenge in Brugada syndrome. Alternative drug is procainamide. Oral flecainide or propafenone are used when intravenous Class I anti arrhythmic agents are not available [1].

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References

  1. Brugada J, Campuzano O, Arbelo E, Sarquella-Brugada G, Brugada R. Present Status of Brugada Syndrome: JACC State-of-the-Art Review. J Am Coll Cardiol. 2018 Aug 28;72(9):1046-1059.
  2. Poli S, Toniolo M, Maiani M, Zanuttini D, Rebellato L, Vendramin I, Dametto E, Bernardi G, Bassi F, Napolitano C, Livi U, Proclemer A. Management of untreatable ventricular arrhythmias during pharmacologic challenges with sodium channel blockers for suspected Brugada syndrome. Europace. 2018 Feb 1;20(2):234-242.