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Review
. 2009 Sep;6(9):1335-41.
doi: 10.1016/j.hrthm.2009.07.002. Epub 2009 Jul 8.

Drugs and Brugada Syndrome Patients: Review of the Literature, Recommendations, and an Up-To-Date Website (www.brugadadrugs.org)

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Free PMC article
Review

Drugs and Brugada Syndrome Patients: Review of the Literature, Recommendations, and an Up-To-Date Website (www.brugadadrugs.org)

Pieter G Postema et al. Heart Rhythm. .
Free PMC article

Abstract

Background: Worldwide, the Brugada syndrome has been recognized as an important cause of sudden cardiac death in individuals at a relatively young age. Importantly, many drugs have been reported to induce the characteristic Brugada syndrome-linked ECG abnormalities and/or (fatal) ventricular tachyarrhythmias.

Objective: The purpose of this study was to review the literature on the use of drugs in Brugada syndrome patients, to make recommendations based on the literature and on expert opinion regarding drug safety, and to ensure worldwide online and up-to-date availability of this information to all physicians who treat Brugada syndrome patients.

Methods: We performed an extensive review of the literature, formed an international expert panel to produce a consensus recommendation to each drug, and initiated a website (www.brugadadrugs.org).

Results: The literature search yielded 506 reports for consideration. Drugs were categorized into one of four categories: (1) drugs to be avoided (n = 18); (2) drugs preferably avoided (n = 23); (3) antiarrhythmic drugs (n = 4); and (4) diagnostic drugs (n = 4). Level of evidence for most associations was C (only consensus opinion of experts, case studies, or standard-of-care) as there are no randomized studies and few nonrandomized studies in Brugada syndrome patients.

Conclusion: Many drugs have been associated with adverse events in Brugada syndrome patients. We have initiated a website (www.brugadadrugs.org) to ensure worldwide availability of information on safe drug use in Brugada syndrome patients.

Figures

Figure 1
Figure 1
Conversion of a normal ECG into a type-1 BrS-ECG during ajmaline challenge. Note the coved-type ST-segments (arrows) in the right precordial ECG leads at peak ajmaline (note V3 is placed in the 3rd intercostal space above V1 [V1ic3], and V5 is placed in the 3rd intercostal space above V2 [V2ic3]).
Figure 2
Figure 2
Non-sustained ventricular tachycardia in a patient who was given flecainide for paroxysmal atrial fibrillation, note the coved-type ST-segments (arrow). The patient was diagnosed with BrS during an ajmaline provocation test.
Figure 3
Figure 3
Screenshot of the website at www.brugadadrugs.org

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