Possible late diagnosis of the Brugada syndrome in a patient presenting with a primary cardiac arrest

Introduction: Idiopathic ventricular fibrillation (IVF) including Brugada syndrome (BS) is one of causes of cardiac arrest without prior overt cardiac dysfunction. Hypothesis: We assessed the hypothesis that patents of IVF had favor outcomes than those of non-IVF after cardiac arrest treated with targeted temperature management (TTM). Methods: Patients who were treated with TTM after cardiac arrest between 2000 and 2019 were enrolled in the study. Patients were divided into 2 groups according to whether the patients were diagnosed as IVF or not. The patients treated with TTM were routinely performed coronary angiography. Results: Among the study patients (N = 306), 35 (11%) patients were IVF and 7 were BS. The patients of the IVF group were significantly younger (median 53 y vs. 64 y) than those of the non-IVF group. The prevalence of initial rhythm was shockable (69% vs. 47%, P = 0.02) was significantly higher in the patients of the IVF group than those of the non-IVF group. Among the patients in the non-IVF group, 114 patients (42%) were diagnosed as acute coronary syndrome and 93 patients (35%) were treated with coronary revascularization. The prevalence of male sex (77% vs 74%, P = 0.70) and witnessed to arrest (80% vs. 81%, P = 0.87), and low-flow time (29 min vs. 38 min [20 - 43 min vs. 21 - 52 min, P = 0.15]) were similar between the 2 groups. The prevalence of performing extracorporeal resuscitation (9% s 43%, P < 0.001) were lower in the patients of the IVF group. The 8-y survival rate were shown in the figure. All of the BS patients were witnessed arrest and were discharged without severe neurological deficit. The IVF as the cause of arrest was independently associated with 8-y survival. Conclusions: The patients of IVF had favor outcomes than those of non-VF. One of causes may be the lower prevalence of requiring extracorporeal circulatory support due to less cardiac dysfunction. The patients of BS had the tendency toward higher survival rate than those of non-BS IVF patients.

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Alternative Approach to Improving Survival of Patients With Out-of-Hospital Primary Cardiac Arrest

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2012.06.064 ◽

2013 ◽

Vol 61 (2) ◽

pp. 113-118 ◽

Cited By ~ 31

Author(s):

Gordon A. Ewy ◽

Arthur B. Sanders

Keyword(s):

Cardiac Arrest ◽

Primary Cardiac Arrest ◽

Alternative Approach

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Brugada Syndrome Inducted Ventricular Fibrillation Successfully Supported With Veno-arterial Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy:A Case Report

10.21203/rs.3.rs-77349/v1 ◽

2020 ◽

Author(s):

Chengfeng Huang ◽

Shifang Huang ◽

Jiawen Huang ◽

Xiaoshen Zhang ◽

Fanna Liu ◽

...

Keyword(s):

Cardiac Arrest ◽

Case Report ◽

Renal Replacement Therapy ◽

Brugada Syndrome ◽

Sudden Cardiac Arrest ◽

The Internet ◽

Asymptomatic Patients ◽

Rescue Treatment ◽

Malignant Arrhythmia ◽

Va Ecmo

Abstract BackgroundThe brugada syndrome（BrS）is an inherited disorder that can lead to sudden death. A young man who experienced sudden cardiac arrest caused by Brs was successfully rescued after 2hour cardiopulmonary resuscitation (CPR). This is a case that has raised concerns in China (more than 200 million people read this news via the internet).Case presentationA 28 years old young man was successfully managed with Veno-arterial ECMO (VA-ECMO) and continuous renal replacement therapy (CRRT) after more than 2 hours CPR. The diagnosis of BrS was identified during ECMO supported, and further ECG screening found two asymptomatic patients. ConclusionBrS can lead to malignant arrhythmia. VA-ECMO is the rescue treatment for patients with cardiac arrest who cannot be cured by conventional resuscitation. VA-ECMO combined with CRRT may help to improve the prognosis of critically ill patients.

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Vigorous Exercise and the Risk of Primary Cardiac Arrest

Silent Myocardial Ischemia ◽

10.1007/978-3-642-69589-6_24 ◽

1984 ◽

pp. 151-155 ◽

Cited By ~ 1

Author(s):

David S. Siscovick

Keyword(s):

Cardiac Arrest ◽

Vigorous Exercise ◽

Primary Cardiac Arrest

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Does time delay between the primary cardiac arrest and PCI affect outcome?

Acta Cardiologica ◽

10.2143/ac.64.5.2042693 ◽

2009 ◽

Vol 64 (5) ◽

pp. 633-637 ◽

Cited By ~ 7

Author(s):

F.M. Szymanski ◽

M. Grabowski ◽

G. Karpinski ◽

A. Hrynkiewicz ◽

K.J. Filipiak ◽

...

Keyword(s):

Cardiac Arrest ◽

Time Delay ◽

Primary Cardiac Arrest

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6081Efficacy and limitations of quinidine therapy in patients with Brugada Syndrome

European Heart Journal ◽

10.1093/eurheartj/ehz746.0125 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Mazzanti ◽

E Tenuta ◽

M Marino ◽

E Pagan ◽

M Morini ◽

...

Keyword(s):

Cardiac Arrest ◽

Side Effects ◽

High Risk ◽

Brugada Syndrome ◽

Low Dose ◽

Clinical Course ◽

High Risk Group ◽

High Dose ◽

Life Threatening ◽

Patients Experience

Abstract Background Quinidine at high-dose is used in patients with Brugada Syndrome (BrS), but its efficacy to prevent life-threatening arrhythmic events (LAE) in BrS is unproven and its use is limited by side effects. Objective We assessed whether low-dose quinidine in BrS patients reduces: 1) the occurrence of a first LAE; 2) the arrhythmic burden in the high-risk group of cardiac arrest survivors. Methods We first compared the clinical course of 53 BrS patients treated with quinidine to that of 441 untreated controls, matched by sex, age, and symptoms. Furthermore, we calculated the annual incidence of LAEs off- and on-quinidine in 123 BrS patients who had survived a cardiac arrest. Results First, we compared the clinical course of 53 BrS patients treated with quinidine (i.e. “cases”: 89% males, median age 40 years) to that of 441 untreated, clinically-matched BrS patients (i.e. “controls”: 91% males, median age 41 years) present in our database of patients with inherited arrhythmias. Cases received quinidine (median dose of 450 mg per day) for 5.0±3.7 years. Quinidine was interrupted in only 3/53 cases (6%) for side effects and it conferred a nonsignificant reduction of the risk of a first LAE in cases versus controls (HR 0.74, 95% CI 0.22–2.48, P=0.62). Secondly, we calculated the annual recurrence of LAE off- and on-quinidine in 123 BrS cardiac arrest survivors, 27 of whom were treated with quinidine for 7.0±3.5 years. The annual rate of recurrent LAEs decreased significantly from 14.7% while off-quinidine to 3.9% while on-quinidine (P=0.03). Notably, recurrent life-threatening arrhythmic events were recorded in 4/27 (15%) symptomatic patients while on-quinidine. Conclusion We demonstrated for the first time in the long-term that low-dose quinidine reduces the recurrence of life-threatening arrhythmias in symptomatic BrS patients, with few side effects. Remarkably, about one-fifth of symptomatic patients experience life-threatening arrhythmias while on-treatment, suggesting that quinidine cannot replace implantable defibrillators in high-risk subjects.

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