Flecainide challenge test: Predictors of unmasking of type 1 Brugada ECG pattern among those with non-type 1 Brugada ECG pattern
Background: Many subjects in community have non-type 1 Brugada pattern ECG with atypical symptoms, relevance of which is not clear. Provocative tests to unmask type 1 Brugada pattern in these patients would help in diagnosing Brugada Syndrome. However sensitivity and specificity of provocating drugs...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2016-03-01
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| Series: | Indian Pacing and Electrophysiology Journal |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S097262921631289X |
| _version_ | 1811264338598559744 |
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| author | Srinivasa Prasad Narayanan Namboodiri Anees Thajudheen Gurbhej Singh Mukund A. Prabhu S.P. Abhilash Krishnakumar Mohanan Nair Aamir Rashid V.K. Ajit Kumar Jaganmohan A. Tharakan |
| author_facet | Srinivasa Prasad Narayanan Namboodiri Anees Thajudheen Gurbhej Singh Mukund A. Prabhu S.P. Abhilash Krishnakumar Mohanan Nair Aamir Rashid V.K. Ajit Kumar Jaganmohan A. Tharakan |
| author_sort | Srinivasa Prasad |
| collection | DOAJ |
| description | Background: Many subjects in community have non-type 1 Brugada pattern ECG with atypical symptoms, relevance of which is not clear. Provocative tests to unmask type 1 Brugada pattern in these patients would help in diagnosing Brugada Syndrome. However sensitivity and specificity of provocating drugs are variable.
Methods: We studied 29 patients referred to our institute with clinical presentation suggestive but not diagnostic of Brugada or with non-Type 1 Brugada pattern ECG. Flecainide Challenge Test (FCT) was done in these patients (IV Flecainide test in 4 patients and Oral Flecainide in 25 patients). Resting 12-lead ECG with standard precordial leads and ECG with precordial leads placed 1 Intercostal space above were performed after flecainide administration every 5 min for first 30 min and every 30 min thereafter until ECG became normal or upto 6 h. The positivity was defined as inducible Type 1 Brugada pattern in atleast 2 right sided leads.
Result: Median age was 35(range = 5–65) years. In 16 (55%) patients the Type 1 Brugada pattern was unmasked. There were no episodes of major AV block, atrial or ventricular tachyarrhythmia. Three groups were considered for analysis: Group 1(n = 9) – FCT Positive among patients with non-type 1 Brugada ECG pattern, Group 2(n = 4) – FCT Negative among the patients with non-type 1 Brugada ECG pattern, and Group 3(n = 7) – FCT Positive among patients with no spontaneous Brugada ECG pattern. Binary logistic regression analysis found that family h/o SCD was predictive of FCT positivity in Group 1 (Odd’s ratio 21, 95% Confidence interval 1.04 to 698.83, p = 0.004).
Conclusion: Oral flecainide is useful and safe for unmasking of Type I Brugada pattern. In our study, among the many variables studied, family history of sudden cardiac death was the only predictor of flecainide test positivity among those with non-Type 1 Brugada pattern. |
| first_indexed | 2024-04-12T20:02:25Z |
| format | Article |
| id | doaj.art-76c0934de0be4ffc94be6fef829e3941 |
| institution | Directory Open Access Journal |
| issn | 0972-6292 |
| language | English |
| last_indexed | 2024-04-12T20:02:25Z |
| publishDate | 2016-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Indian Pacing and Electrophysiology Journal |
| spelling | doaj.art-76c0934de0be4ffc94be6fef829e39412022-12-22T03:18:30ZengElsevierIndian Pacing and Electrophysiology Journal0972-62922016-03-01162535810.1016/j.ipej.2016.06.001Flecainide challenge test: Predictors of unmasking of type 1 Brugada ECG pattern among those with non-type 1 Brugada ECG patternSrinivasa PrasadNarayanan NamboodiriAnees ThajudheenGurbhej SinghMukund A. PrabhuS.P. AbhilashKrishnakumar Mohanan NairAamir RashidV.K. Ajit KumarJaganmohan A. TharakanBackground: Many subjects in community have non-type 1 Brugada pattern ECG with atypical symptoms, relevance of which is not clear. Provocative tests to unmask type 1 Brugada pattern in these patients would help in diagnosing Brugada Syndrome. However sensitivity and specificity of provocating drugs are variable. Methods: We studied 29 patients referred to our institute with clinical presentation suggestive but not diagnostic of Brugada or with non-Type 1 Brugada pattern ECG. Flecainide Challenge Test (FCT) was done in these patients (IV Flecainide test in 4 patients and Oral Flecainide in 25 patients). Resting 12-lead ECG with standard precordial leads and ECG with precordial leads placed 1 Intercostal space above were performed after flecainide administration every 5 min for first 30 min and every 30 min thereafter until ECG became normal or upto 6 h. The positivity was defined as inducible Type 1 Brugada pattern in atleast 2 right sided leads. Result: Median age was 35(range = 5–65) years. In 16 (55%) patients the Type 1 Brugada pattern was unmasked. There were no episodes of major AV block, atrial or ventricular tachyarrhythmia. Three groups were considered for analysis: Group 1(n = 9) – FCT Positive among patients with non-type 1 Brugada ECG pattern, Group 2(n = 4) – FCT Negative among the patients with non-type 1 Brugada ECG pattern, and Group 3(n = 7) – FCT Positive among patients with no spontaneous Brugada ECG pattern. Binary logistic regression analysis found that family h/o SCD was predictive of FCT positivity in Group 1 (Odd’s ratio 21, 95% Confidence interval 1.04 to 698.83, p = 0.004). Conclusion: Oral flecainide is useful and safe for unmasking of Type I Brugada pattern. In our study, among the many variables studied, family history of sudden cardiac death was the only predictor of flecainide test positivity among those with non-Type 1 Brugada pattern.http://www.sciencedirect.com/science/article/pii/S097262921631289X |
| spellingShingle | Srinivasa Prasad Narayanan Namboodiri Anees Thajudheen Gurbhej Singh Mukund A. Prabhu S.P. Abhilash Krishnakumar Mohanan Nair Aamir Rashid V.K. Ajit Kumar Jaganmohan A. Tharakan Flecainide challenge test: Predictors of unmasking of type 1 Brugada ECG pattern among those with non-type 1 Brugada ECG pattern Indian Pacing and Electrophysiology Journal |
| title | Flecainide challenge test: Predictors of unmasking of type 1 Brugada ECG pattern among those with non-type 1 Brugada ECG pattern |
| title_full | Flecainide challenge test: Predictors of unmasking of type 1 Brugada ECG pattern among those with non-type 1 Brugada ECG pattern |
| title_fullStr | Flecainide challenge test: Predictors of unmasking of type 1 Brugada ECG pattern among those with non-type 1 Brugada ECG pattern |
| title_full_unstemmed | Flecainide challenge test: Predictors of unmasking of type 1 Brugada ECG pattern among those with non-type 1 Brugada ECG pattern |
| title_short | Flecainide challenge test: Predictors of unmasking of type 1 Brugada ECG pattern among those with non-type 1 Brugada ECG pattern |
| title_sort | flecainide challenge test predictors of unmasking of type 1 brugada ecg pattern among those with non type 1 brugada ecg pattern |
| url | http://www.sciencedirect.com/science/article/pii/S097262921631289X |
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