1. Brugada Patient and the Environment: Harmful Factors and Drugs
Juhani Junttila, MD
Insitute of Clinical Medicine,
University of Oulu, Oulu, Finland

2. Case 50 yrs male Paroxysmal Afib Treated with flecainide
No family history of SCD
No syncopal episodes

3. Case
Flecainide discontinued
RBBB underlying morphology??

4. Induced Brugada ECG
Patients with induced Brugada ECG by medication of by fever are at imminent risk for ventricular arrhythmias
In a case series of 47 patients with induced Brugada ECG 51% developed ventricular arrhythmias
Most cases had ventricular arrhythmias during fever or during anesthesia
Junttila MJ et al. Circulation 2008

5. Ion channel effects
Ito
Ito
ICa
INa
IKr
INa
IKs

6. Fever Current decay for WT (squares) and
Thr1620Met (circles) at 22°C (▪, •) and 32°C (□, ○).
Dumaine R et al. Circulation Research 1999;85:

7. Fever 402 patients with fever (>38°) and 909 without
2% (n= 8) type I Brugada ECG in fever patients
0.1% in controls, p< 0.001
Four had diagnostic finging of the syndrome after fever
One Brugada ECG in repeated ECG
Three with positive ajmaline test
All patients with Brugada ECG were asymptomatic and remained asymptomatic during 30mo of follow up
Adler A et al. Heart Rhythm. 2013

8. Fever

11. Sauna and Hot Tub
Sauna: 30min in 80C° core temperature increase ~1C° in adults and ~2C° in children
Leppäluoto J. Ann Clin Res. 1988;20(4):240-3
Hot tub: 15min of 40C° increased core body temperature by ~0.6C°
Allison TG, Miller TD, Squires RW et al.
Mayo Clin Proc. 1993 Jan;68(1):19-25.

12. Sports Strenuous indurance training might be harmful
Increase in vagal tone?
Leisure-time sport activity might not be harmful
Patients with ICD should be restricted from competetive sports?
Sports with low cardiovascular demand should be allowed
Heidbüchel H et al. Study Group on Sports Cardiology of the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil. 2006

13. Other factors Hypokalemia Glucose-insulin infusion
Araki T et al. Circ J. 2003
Glucose-insulin infusion
Nogami A et al. Pacing Clin Electrophysiol. 2003

14. Drugs –avoided
Postema et al. Heart Rhythm and Postema et al. Europace 2013

15. Drugs –preferably avoided
Postema et al. Heart Rhythm and Postema et al. Europace 2013

16. Drugs Propofol infusion syndrome Well known among anesthesiologists
Brugada ECG among first warning signs
Lactic acidosis results in organ failure

17. Conclusion
Antzelevitch C et al. Circulation 2005;111: