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Diagnosed with heart arrythmia and Brugada syndrome, was taking Flecainide. Need another opinion.

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Cardiologist, Interventional
Practicing since : 1996
Answered : 192 Questions
I am 38, 150lbs 5'3" male. Recently diagnosed with hear arrhythmia
and it was suggested that I do an EP study. Saw specialist today and did ECG after which she said I had Brugada syndrome. I need another opinion. I was on Flecanide at the time which she has now stopped
Posted Sun, 15 Apr 2012 in Hypertension and Heart Disease
Answered by Dr. Raja Sekhar Varma 12 hours later

Thank you for your query.

I understand that you are a 38 year old male of Asian origin with symptomatic Arrhythmia.

I have seen the ECG that you have uploaded. This ECG shows the characteristic changes of incomplete RBBB (right bundle branch block) pattern with coving ST elevation in V1 and V2 with T inversion, which is almost diagnostic of Brugada syndrome. The diagnosis is all the more likely to be correct since you were on Flecainide at the time, which usually unmasks the syndrome.

In addition, the stress test report also clearly documents a Ventricular tachycardia preceded by a Supra-ventricular Tachycardia.

From these reports, the diagnosis of Brugada syndrome should be strongly considered.

You need to do some supportive investigations like echo, serum potassium and calcium levels, cardiac enzyme levels (CK MB and Troponin) and if required, MRI of the heart to rule out structural changes in the RVOT (Right ventricular outflow tract) and arrhythmogenic RV dysplasia.

Brugada syndrome is thought to be due to mutations that occur in certain types of sodium channels in the cardiac muscle. This predisposes the individual to arrhythmias and sudden cardiac death.

The ideal and essential treatment in your case would be to implant an automatic intracardiac cardioverter-defibrillator (AICD). I would recommend you to get this done at the earliest. This will be life-saving as well. There are no drugs of proven efficacy.

I hope this answers your query. Feel free to get back to me if you need any further clarifications.

With regards,
Dr RS Varma
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