Brugada syndrome: a disease causing dangerous arrhythmias

Currently, cardiovascular disease is the leading cause of death worldwide. Prominent among them are the causes of coronary artery disease and arrhythmia. There are types of arrhythmias of long-lasting and chronic nature. Some arrhythmias are emergency, life-threatening conditions. These arrhythmias are usually ventricular arrhythmias. They often occur in a group of high-risk subjects, with underlying cardiovascular disease… In this article, we learn about an arrhythmia that can cause sudden death: Brugada syndrome. In this syndrome, arrhythmias can cause sudden death if not previously noted.

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    What is Brugada syndrome?

  • Brugada syndrome is a primary electrical and ion channel disease of the heart. It is characterized by ST segment elevation in the right precordial lead. This syndrome does not have structural cardiac abnormalities. Patients often have episodes of syncope or sudden death due to ventricular tachycardia or ventricular fibrillation.

Brugada syndrome: a disease causing dangerous arrhythmias

  • Brugada syndrome is an inherited disease caused by mutations in the gene encoding the α subunit of the cardiac Na channel, the SCN5A gene, located on chromosome 3 (autosomal dominant). Therefore, this pathology is often familial.
  • Gene mutations cause: decreased expression of Na channel, decreased flow of Na ions, increased inactivation of Na . channels
  • In patients with only electrocardiographic findings without clinical symptoms, this is called Brugada's sign. It is called a syndrome when both of the above factors are present.

Brugada syndrome: a disease causing dangerous arrhythmias

Genetic traits

  1. What is the risk of Brugada syndrome?

Due to the genetic mutation origin and not related to the heart structure, complications of Brugada HC can occur in people with a healthy history. Although the disease is rare, it is very dangerous, with a high mortality rate if it causes dangerous arrhythmias. The most common complications of the disease are:

  • Sudden death. Sudden cardiac arrest due to arrhythmia. Patients can suddenly have cardiac arrest, stop breathing and lose consciousness, with a high mortality rate. However, with quick and accurate first aid, the patient's life can still be saved.
  • Faint. Cardiac arrhythmias that do not cause cardiac arrest can reduce blood flow to the brain, causing fainting. A history of syncope is a danger sign for a patient diagnosed with Brugada syndrome.

See more: Cardiovascular disease – Do you really know and understand it correctly?

  1. Who is at risk for Brugada syndrome?

HC brugada appeared unexpectedly and without warning signs. Therefore, it is necessary to carefully screen people with risk factors for timely intervention. The nature of gene mutation is due to each person's location, so in other words, the risk factor is the condition for expressing this gene outside the body. People with the following characteristics have a higher risk of experiencing Brugada syndrome:

  • Family history of Brugada syndrome. If a family member has Brugada syndrome, the risk is higher. About 30% of patients are found to have genetic abnormalities.
  • Male gender: Men are more often diagnosed with Brugada syndrome than women. Manifestations are usually in adults, age of sudden death #40.
  • Race: Brugada syndrome is more common in Asian people, especially in Japan and countries in South Asia.
  1. What are the signs of Brugada syndrome?

Many people with Brugada syndrome go undiagnosed. Because this problem usually doesn't cause any noticeable signs or symptoms. The most important sign of Brugada syndrome is the abnormal heart rhythm seen on the electrocardiogram - ECG. Brugada sign may be present but not Brugada syndrome. However, signs and symptoms that may mean you have Brugada syndrome include:

  • Faint.
  • Heart beats irregularly.
  • Thrill, palpitations.
  • Dizzy.
  • Sudden cardiac arrest.

Brugada syndrome has signs and symptoms similar to some other heart rhythm problems. Therefore, it is necessary to carefully investigate to get the correct and reasonable intervention.

See more: Tips on how to prevent bradycardia

Brugada syndrome: a disease causing dangerous arrhythmias

Fainting is a common symptom

  1. Classification of Brugada's syndrome

Classification of Brugada syndrome based on electrocardiographic findings. There are 3 types of Brugada HC, the most dangerous is type 1. The criteria are as follows:

  • Type 1. J-wave amplitude 2mm, Negative T-wave, Domed ST-T shape, Steady down-sloping ST segment (end part)
  • Type 2. J wave amplitude 2mm, Positive or biphasic T wave, ST-T shape Saddle pattern, ST segment (end part) elevation ≥1mm
  • Type 3. J wave amplitude ≥ 2mm, Positive T wave, Saddle ST-T shape, ST segment (end part) elevation ≤1mm

Type 1 has a severe prognosis and indicates earlier intervention or the other type.

Brugada syndrome: a disease causing dangerous arrhythmias

  1. How is Brugada syndrome diagnosed?

A full diagnosis of Brugada syndrome requires a combination of history, clinical examination and laboratory tests.

QUESTIONS OF DISEASE

  • It is necessary to carefully exploit the family history, especially the history of fainting and sudden death
  • Ask carefully about the patient's symptoms of syncope and palpitations

CLINICAL EXAMINATION

  • Look for arrhythmias and signs of cardiovascular disease.

TEST

Tests used in the diagnosis of Brugada syndrome are:

  • Electrocardiogram (ECG). Brugada syndrome can manifest on the electrocardiogram even in the absence of symptoms. In some cases, ECG findings appear only in the presence of predisposing factors. Electrocardiographic criteria are outlined in the classification of Brugada syndrome types. Sometimes the doctor may order an electrocardiogram for 24 hours to detect the ECG findings.
  • Echocardiography. Ultrasonography is of little value in the diagnosis of Brugada syndrome. The test aims to examine the structure of the heart and find associated cardiovascular diseases.
  • Electrophysiological investigation of the chambers of the heart. After you are sedated, your doctor will use a catheter in a vein in your leg to access your heart. Electrical stimulation on each site of the heart will receive its electrical overview. From there, find the abnormal location causing the arrhythmia.
  • Genetic testing. About 30% of patients have problems with the gene that keeps the heart rhythm normal. Detection of ion channel gene abnormalities. If there is a family history of Brugada syndrome, screening is recommended.

Brugada syndrome: a disease causing dangerous arrhythmias

  1. How is Brugada syndrome treated?

Treatment for Brugada syndrome depends on the risk of serious arrhythmias. The risk is high if the patient has:

  • Personal history of serious arrhythmia problems
  • Faint
  • Surviving sudden cardiac arrest
  • Family history of Brugada syndrome of sudden death.

If you don't have any symptoms, no specific treatment is needed because the risk is low. However, motivating factors should be avoided by:

  • Treatment of stable medical background diseases, especially cardiovascular diseases.
  • Actively treat fever. Fever is a predisposing factor for an irregular heartbeat in people with Brugada syndrome. So use fever reducer at the first sign of fever.
  • Avoid medications that can cause an irregular heartbeat. Many medications can increase your risk of an irregular heartbeat, including some heart medications and antidepressants.
  • Do not drink alcohol. Drinking too much alcohol can also increase your risk.
  • Avoid playing high intensity sports.

DEVELOPMENT TREATMENTS

If life-saving after cardiac arrest or worrisome symptoms, more intensive treatment is needed:

  • Implantable defibrillator (ICD). This small, battery-operated device is placed in the chest to continuously monitor heart rate. When an arrhythmia is present, the machine delivers electrical shocks as needed to control the abnormal heart rhythm. The ICD can cause unnecessary shocks when it is not needed. Therefore, it is important to correct the indications and weigh the benefits of treatment.
  • Electrophysiological ablation. If an ICD does not effectively and safely control Brugada syndrome symptoms, a procedure called radiofrequency electrophysiological ablation may be an option. A long, flexible tube (catheter) is inserted through a blood vessel and threaded to the heart. Using high-energy waves scar or destroy the heart tissue responsible for the abnormal heart rhythm. The ablation process is very complicated, it is possible that incomplete burning of the target tissue leads to the recurrence of arrhythmias.
  • Drug treatment. The aim of the drug is to restore the active ionic balance in the electrical activity of the heart. Medications such as quinidine and β-adrenergic agonists are used to prevent dangerous heart rhythms. This medicine may be given together with patients who have had an ICD placed.

Brugada syndrome: a disease causing dangerous arrhythmias

Electrophysiological ablation

  1. How to monitor patients with Brugada syndrome?

  • For those who have had electrophysiological ablation or placed an ICD, it is necessary to have regular check-ups and closely monitor their own symptoms. The frequent pulsed ICD indicates that the mechanisms underlying the arrhythmia have not been resolved. Need for electrophysiological intervention or medication to control. Electrophysiological ablation requires close monitoring because incomplete ablation of the target tissue may cause recurrence.
  • For patients with no indication for intervention. Regular physical exams and lifestyle changes that limit predisposing factors will help reduce the risk of dangerous arrhythmias.
  • Limit alcohol consumption and overexertion.
  • People with Brugada syndrome should remind their children and family members to monitor and have regular health checkups.

Brugagda syndrome is a rare but potentially serious illness. In particular, the disease may have no warning symptoms in healthy people. When an arrhythmia occurs, the mortality rate is high due to the lack of timely intervention. Current treatment methods are very effective. Early detection, risk control and prompt treatment are the keys to managing Brugada syndrome.

Doctor Luong Si Bac


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