The Brugada syndrome: pharmacological therapy

Area of Science:

• Cardiology
• Genetics
• Pharmacology

Background:

• Brugada syndrome is an inherited channelopathy increasing risk of sudden cardiac death (SCD) from ventricular arrhythmias (VA).
• Current guidelines recommend implantable cardioverter-defibrillators (ICDs) for SCD prevention, but they do not prevent VA recurrence.

Purpose of the Study:

• To review the literature on pharmacological therapy for Brugada syndrome, focusing on quinidine.
• To evaluate quinidine's efficacy in preventing ventricular and supraventricular arrhythmias in Brugada syndrome.

Main Methods:

• Review of existing literature on quinidine treatment for Brugada syndrome.
• Analysis of studies involving patients with ICDs, recurrent shocks, or inducible ventricular fibrillation (VF).
• Assessment of quinidine's use in preventing supraventricular arrhythmias and in pediatric patients.

Main Results:

• Quinidine demonstrated efficacy in preventing ventricular fibrillation re-induction and spontaneous ventricular arrhythmias in Brugada syndrome patients.
• Studies showed quinidine is effective in preventing supraventricular arrhythmias, including atrial fibrillation/flutter.
• Quinidine proved effective in both adult and pediatric Brugada syndrome patients.

Conclusions:

• Quinidine is an effective pharmacological option for preventing both ventricular and supraventricular arrhythmias in Brugada syndrome.
• Despite its efficacy, quinidine therapy is associated with a high incidence of side effects, potentially leading to treatment discontinuation.