Retrospective single center experience use of propofol for general anesthesia in Brugada patients

In Brugada Syndrome patients (BrS), use of propofol for general anesthesia (GA) is still a matter of debate. Propofol is theoretically not recommended in these patients, but data is lacking. The objective was to assess the safety of propofol infusion use during GA in BrS patients. From our database of BrS patients, we retrospectively enrolled, every patient who underwent a surgery or a medical intervention under GA with propofol infusion. From January 2009 to September 2021, 106 BrS patients underwent at least one procedure under GA. At time of diagnosis, mean age was 45.2 ± 12.7 years, 76.4% were males, 50.9% were symptomatic (syncope 39.6%, aborted sudden cardiac death 11.3%), 77.3% were probands, 21.7% reported a first-degree sudden cardiac death history. Diagnosis was made in presence of a BrS pattern 31 ECG lead, either spontaneously (n = 56) or after a class IC antiarrhythmic drug infusion provocation test (n = 50). Genetic testing found a SCN5A mutation in 19.8% of patients. Programmed ventricular stimulation was performed in 50 patients and was positive for 41 of them. After baseline evaluation, 89.6% patients received an implantable cardiac defibrillator of which 32.6% in primary prevention. A total of 150 procedures under GA with propofol infusion were performed (21 patients with 32 GA, maximum 6 GA per patient): 105 implantable cardiac defibrillator implantation or replacement, 24 extra-cardiac surgeries, 16 ventricular arrhythmias ablation procedures and 4 cardiac surgeries. In all procedures close cardiac monitoring was performed. For all these GA, there was no apparition or increase of BrS pattern, and except for the ventricular arrhythmias ablation procedures, there was no ventricular arrythmia event reported. In BrS patients, use of propofol infusion for GA procedures with close cardiac monitoring seems to be safe.