Brugada Syndrome 

 

 

Background 

 

  • Brugada syndrome is a rare autosomal dominant disease & is associated with sudden cardiac death from ventricular fibrillation or tachycardia (VT/VF), especially in Southeast Asian males 

 

 

Anesthetic Considerations 

 

  • Potential for hemodynamic collapse due to VT & VF

  • Avoid exacerbating factors of Brugada (ST Elevation):

    • Parasympathetic nervous system stimulation (increase in vagal tone)

    • Medications

      • Avoid BB, alpha agonists, neostigmine

      • Avoid class Ia antiarrhythmic (procainamide)

    • Electrolyte abnormalities: ↑↓K, ↑Ca

    • Fever 

  • Considerations of AICD if in situ (only known treatment) 

  • Preparations for treating Brugada Exacerbations or cardiac arrest:

    • All patients without AICD need defibrillator & pads in OR

    • Atropine, Ephedrine, Isoproterenol 

  • Resuscitation drugs should be available

 

 

Typical ECG findings

  • Characteristic findings are RBBB & ST elevation in V1-V3

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