An aggressive protocol of programmed ventricular stimulation was performed in 96 patients with
Brugada syndrome (88% males; mean age, 39.8±15.9 years). Ten patients were
cardiac arrest survivors, 27 had presented with
syncope, and 59 were asymptomatic.
Ventricular fibrillation was induced in 66 patients, including 100%, 74%, and 61% of patients with
cardiac arrest,
syncope, and no symptoms, respectively. All but 6 of the 66 patients with inducible
ventricular fibrillation underwent electrophysiological testing on
quinidine (n=54),
disopyramide (n=2), or both (n=4). Fifty-four (90%) patients were electrophysiological responders to >1 AAD with similar efficacy rates (≈90%) in all patients groups. Patients with no inducible
ventricular fibrillation at baseline were left on no
therapy. After a mean follow-up of 113.3±71.5 months, 92 patients were alive, whereas 4 died from noncardiac causes. No arrhythmic event occurred during class 1A AAD
therapy in any of electrophysiological
drug responders and in patients with no baseline inducible
ventricular fibrillation. Arrhythmic events occurred in only 2
cardiac arrest survivors treated with
implantable cardioverter-defibrillator alone but did not recur on
quinidine. All cases of recurrent
syncope (n=12) were attributed to a vasovagal (n=10) or nonarrhythmic mechanism (n=2). Class 1A AAD
therapy resulted in 38% incidence of side effects that resolved after
drug discontinuation.
CONCLUSIONS: