Brugada Patient and the Environment: Harmful Factors and Drugs Juhani Junttila, MD Insitute of...
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![Page 1: Brugada Patient and the Environment: Harmful Factors and Drugs Juhani Junttila, MD Insitute of Clinical Medicine, University of Oulu, Oulu, Finland.](https://reader035.fdocuments.us/reader035/viewer/2022062618/5513dd4555034679748b5292/html5/thumbnails/1.jpg)
Brugada Patient and the Environment:Harmful Factors and Drugs
Juhani Junttila, MDInsitute of Clinical Medicine, University of Oulu, Oulu, Finland
![Page 2: Brugada Patient and the Environment: Harmful Factors and Drugs Juhani Junttila, MD Insitute of Clinical Medicine, University of Oulu, Oulu, Finland.](https://reader035.fdocuments.us/reader035/viewer/2022062618/5513dd4555034679748b5292/html5/thumbnails/2.jpg)
Case
• 50 yrs male• Paroxysmal Afib• Treated with
flecainide• No family history of
SCD• No syncopal
episodes
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Case
• Flecainide discontinued
• RBBB underlying morphology??
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Induced Brugada ECG
• Patients with induced Brugada ECG by medication of by fever are at imminent risk for ventricular arrhythmias– In a case series of 47 patients with induced
Brugada ECG 51% developed ventricular arrhythmias
• Most cases had ventricular arrhythmias during fever or during anesthesia
Junttila MJ et al. Circulation 2008
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Ion channel effects
IKr
IKs
Ito
INa
ICa
INa
Ito
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Current decay for WT (squares) and Thr1620Met (circles) at 22°C (▪, •) and 32°C (□, ○).
Dumaine R et al. Circulation Research 1999;85:803-809
Fever
![Page 7: Brugada Patient and the Environment: Harmful Factors and Drugs Juhani Junttila, MD Insitute of Clinical Medicine, University of Oulu, Oulu, Finland.](https://reader035.fdocuments.us/reader035/viewer/2022062618/5513dd4555034679748b5292/html5/thumbnails/7.jpg)
Fever
• 402 patients with fever (>38°) and 909 without
• 2% (n= 8) type I Brugada ECG in fever patients– 0.1% in controls, p< 0.001– Four had diagnostic finging of the syndrome after
fever• One Brugada ECG in repeated ECG• Three with positive ajmaline test
• All patients with Brugada ECG were asymptomatic and remained asymptomatic during 30mo of follow up
Adler A et al. Heart Rhythm. 2013
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Fever
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![Page 11: Brugada Patient and the Environment: Harmful Factors and Drugs Juhani Junttila, MD Insitute of Clinical Medicine, University of Oulu, Oulu, Finland.](https://reader035.fdocuments.us/reader035/viewer/2022062618/5513dd4555034679748b5292/html5/thumbnails/11.jpg)
Sauna and Hot Tub
• Sauna: 30min in 80C° core temperature increase ~1C° in adults and ~2C° in children– Leppäluoto J. Ann Clin Res. 1988;20(4):240-3
• Hot tub: 15min of 40C° increased core body temperature by ~0.6C° – Allison TG, Miller TD, Squires RW et al. Mayo Clin Proc. 1993 Jan;68(1):19-25.
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Sports
• Strenuous indurance training might be harmful – Increase in vagal tone?
• Leisure-time sport activity might not
be harmful• Patients with ICD should be
restricted from competetive sports?– Sports with low cardiovascular demand
should be allowedHeidbüchel H et al. Study Group on Sports Cardiology of the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil. 2006
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Other factors
• HypokalemiaAraki T et al. Circ J. 2003
• Glucose-insulin infusionNogami A et al. Pacing Clin Electrophysiol.
2003
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Drugs –avoided
www.brugadadrugs.org Postema et al. Heart Rhythm 2009 and Postema et al. Europace 2013
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Drugs –preferably avoided
www.brugadadrugs.org Postema et al. Heart Rhythm 2009 and Postema et al. Europace 2013
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Drugs
Propofol infusion syndrome• Well known among anesthesiologists• Brugada ECG among first warning
signs • Lactic acidosis results in organ
failure
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Conclusion
Antzelevitch C et al. Circulation 2005;111:659-670
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