Brugada Syndrome Medication

Updated: Jan 09, 2017
  • Author: Jose M Dizon, MD; Chief Editor: Jeffrey N Rottman, MD  more...
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Medication

Medication Summary

Theoretically, drugs that counteract the ionic current imbalance in Brugada syndrome could be used to treat it. For example, quinidine, which blocks the calcium-independent transient outward potassium current (Ito), has been shown to normalize the ECG pattern in patients with Brugada syndrome. [3] However, quinidine also blocks sodium (Na) currents, which could have contrary effects.

Tedisamil, a potent Ito blocker without strong Na channel effects, may be more effective than quinidine. [41] Isoproterenol, which boosts the L-type calcium current, can also counteract the ionic current imbalance. [41]

Thus far, no drug therapy for Brugada syndrome is recommended because clinical trials have failed to convincingly prove effectiveness. [22, 42, 43, 44] A number of medications can unmask the Brugada pattern on ECG and potentially exacerbate the clinical manifestations of Brugada syndrome. The Web site BrugadaDrugs.org has been established to educate patients and professionals about these potentially dangerous medications. [45]

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Antiarrhythmic Drugs

Class Summary

There is general consensus that certain drugs can be potentially antiarrhythmic in Brugada syndrome patients. However, there are no randomized clinical studies in Brugada syndrome patients. As such, only in the setting of long-term therapeutic treatment in an experienced medical center can practitioners consider the use of antiarrhythmics for high-risk patients. Currently, quinidine seems to be the treatment of choice for long-term therapy.

Quinidine

Quinidine maintains a normal heart rhythm following cardioversion of atrial fibrillation or flutter. It depresses myocardial excitability and conduction velocity. Prior to administration, control the ventricular rate and CHF (if present) with digoxin or calcium channel blockers.

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