Time to positivity of diagnostic provocative pharmacologic testing in Brugada syndrome

Spontaneous type 1 electrocardiographic pattern (sECG) in patients with Brugada syndrome (BrS) is a negative prognostic factor, as are a history of aborted sudden death and arrhythmic syncope. Data from the FINGER (France, Italy, Netherlands, Germany) Registry suggest that, in asymptomatic patients, the presence of sECG doubles the risk of experiencing a life-threatening arrhythmic event (0.81% per year vs 0.35% per year). 1 Probst V. Veltmann C. Eckardt L. et al. Long-term prognosis of patients diagnosed with Brugada syndrome: results from the FINGER Brugada Syndrome Registry. Circulation. 2010; 121: 635-643 Crossref PubMed Scopus (635) Google Scholar Considering that the daily burden of sECG is variable, 12-lead 24-hour Holter monitoring (12L-Holter) might show the presence of intermittent sECG in up to 20% of patients who originally present with drug-induced type 1 pattern (diECG). 2 Cerrato N. Giustetto C. Gribaudo E. et al. Prevalence of type 1 Brugada electrocardiographic pattern evaluated by twelve-lead twenty-four-hour Holter monitoring. Am J Cardiol. 2015; 115: 52-56 Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar In this study, which was approved by the ethical committee of our institution, we tested the hypothesis that earlier test positivity during diagnostic pharmacologic challenge with sodium channel blockers in drug-induced BrS patients may indicate a higher propensity to show sECG during follow-up.