Brugada syndrome
Brugada syndrome is a disease with abnormal electrical properties of heart cells that increases the risk of fatal cardiac arrhythmia—ventricular fibrillation. When the disease strikes, a patient will experience a sudden cardiac arrest with an 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 times more common in males than females, most often between the ages 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 high consumption of carbohydrates (rice, flour, and sugar), strenuous exercise or harsh physical labor, alcohol intake, high fever, or usage of certain addictive drugs.
What is the treatment and prevention of Brugada syndrome?
To prevent death from fatal arrhythmia, a Brugada syndrome patient who survived a previous episode of a heart arrhythmia attack is recommended to have an implant of an automatic implantable cardioverter-defibrillator (AICD), which will constantly monitor the heart’s electrical signal. If ventricular fibrillation occurs, an 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.
Who is at risk of Brugada syndrome?
- Individuals with a family history of Brugada syndrome or sudden death during sleep of unknown cause
- Individuals with an abnormal ECG typical of the Brugada pattern
- Individuals who survive loss of consciousness or nocturnal seizure of unknown cause
- Individuals who experience unarousable sleep or have seizures during sleep of unknown cause and recover without treatment.
Individuals who have experience with the above list are recommended to consult a cardiologist for thorough investigations and diagnosis of Brugada syndrome due to the magnitude of risk for fatal cardiac arrhythmia and cardiac arrest and whether an AICD implant is necessary.
