Unexplained nocturnal death syndrome (known as “LaiTai” disease in Thailand) or Brugada syndrome, a disease with abnormal electrical property of heart cells increases the risk of fatal cardiac arrhythmia -- ventricular fibrillation. When it strikes, patient will suffer a sudden cardiac arrest with abrupt stop of pulse and blood circulation. If the irregular heart rhythm does not resolve on its own or the patient does not receive immediate cardiac resuscitation, it will lead to sudden cardiac death in a few minutes.
Brugada syndrome is hereditary. In Thailand, the highest incidence of Brugada syndrome is in the northeastern region, followed by the northern region. It is many folds more common in male than female, most often between the age of 25-55. There are no prodromal, warning signs. Patients lose consciousness from sudden cardiac arrest during sleep. Precipitating factors found to be related to fatal arrhythmic events include such high consumption of carbohydrate (rice, flour, and sugar), strenuous exercise or harsh physical labors, alcohol intake, high fever, or certain addictive drugs usage.
Treatment and prevention
To prevent death from fatal arrhythmia, “LaiTai” patient who survived previous episode of arrhythmic attack is recommended to have an implant of automatic implantable cardio defibrillator (AICD) which will constantly monitor the heart’s electrical signal. If ventricular fibrillation occurs, AICD can send an electric jolt (defibrillation) to restore a normal heart rhythm in a matter of seconds. It is a highly effective method to prevent cardiac death. Currently, there is research involving inserting an intracardiac catheter to locate and deliver electrical energy to ablate abnormal foci within the heart which may be able to prevent ventricular fibrillation. However, there is no consensus that this new treatment modality is ready to replace the proven AICD implant.
The followings are patients with high risk for ‘’LaiTai’’ or Brugada syndrome:
- Family history of Brugada syndrome or sudden death during sleep of unknown cause
- Abnormal ECG typical of Brugada pattern
- Patient who survive loss of consciousness or nocturnal seizure of unknown cause
- Patient unarousable from sleep or has seizure during sleep of unknown cause who recover without treatment.
They are recommended to consult a cardiologist for thorough investigations and diagnosis of Brugada syndrome, the magnitude of risk for fatal cardiac arrhythmia and cardiac arrest as well as whether AICD implant is mandatory.
