Risk of Spontaneous vs Induced Brugada Pattern

Risk of Spontaneous vs Induced Brugada Pattern

It is well known that sodium channel blockers can unmask the ECG pattern in Brugada syndrome. A recent systematic review and meta-analysis evaluated the utility of drug challenge in testing for Brugada syndrome. They found that spontaneous type 1 ECG characterized by coved, down sloping ST elevation with T inversion in right precordial leads had 2.4% annual incidence of serious arrhythmic events. In contrast, those with ECG pattern induced by sodium channel blockers had only 0.65% annual incidence of serious arrhythmic events.

Reference

1. Rattanawong P, Kewcharoen J, Kanitsoraphan C, Vutthikraivit W, Putthapiban P, Prasitlumkum N, Mekraksakit P, Mekritthikrai R, Chung EH. The utility of drug challenge testing in Brugada syndrome: A systematic review and meta-analysis. J Cardiovasc Electrophysiol. 2020 Sep;31(9):2474-2483. doi: 10.1111/jce.14631. Epub 2020 Jul 9. PMID: 32573844.