?url_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Adc&rft.title=Role+of+pharmacotherapy+in+Brugada+syndrome++&rft.creator=Tsuchiya%2C+Takeshi&rft.subject=Indian+Pacing+and+Electrophysiology+Journal&rft.description=In+patients+who+undergo+aborted+sudden+cardiac+death+or+syncope+of+unknown+origin+(symptomatic+Brugada+syndrome)%2C+no+one+argues+that+the+implantation+of+an+ICD+is+the+first-line+therapy+regardless+of+the+findings+of+the+EP+study.++For+those+patients%2C+drug+therapy+plays+not+a+contradictory+but+a+complimentary+role+to+the+ICD+by+reducing+the+number+of+ICD+shock+deliveries.++Prevention+of+VF+contributes+to+the+improvement+in+the+quality+of+life+of+the+patients+by+avoiding+uncomfortable+ICD+shock+deliveries.%0A++++++++++++As+mentioned+above%2C+Belhassen+et+al.+11%2C+performed+EP-guided+medical+therapy+in+34+patients+with+idiopathic+VF%2C+in+5+of+whom+the+criterion+of+Brugada+syndrome+were+fulfilled%2C+and+reported+excellent+long-term+results.+Although+medical+therapy+requires+markers+that+can+accurately+predict+the+preventive+effect+of+VF+over+a+long-term+period%2C+there%2C+however%2C+seems+to+be+no+reliable+marker.++An+EP+study+is+usually+used+to+examine+the+preventive+effects+of+antiarrhythmic+agents+on+sustained+ventricular+tachycardia+in+patients+with+structural+heart+disease%2C+whereas+the+prognostic+value+of+the+EP+study+in+predicting+life-threatening+events+in+Brugada+syndrome+is+still+controversial.++Brugada+et+al.%2C+3+suggested+that+among+the+asymptomatic+patients%2C+the+inducibility+of+VT+during+the+EP+study+might+be+a+prognostic+marker+of+risk.++Studies+by+Priori+et+al.%2C+22+and+Kanda+et+al.%2C+23+failed+to+find+an+association+between+the+inducibility+and+recurrence+of+VT%2FVF+in+patients+with+Brugada+syndrome+regardless+of+whether+it+was+symptomatic+or+asymptomatic.++As+Belhassen+suggested+13%2C+the+difference+might+be+due+to+the+VF+induction+protocol+in+the+EP+study%2C+in+which+Belhassen+et+al.%2C+used+a+stimulus+current+intensity+of+five+times+the+diastolic+threshold+along+with+the+use+of+repetition+of+double+and+triple+extrastimulation+at+the+shortest+coupling+intervals+that+resulted+in+ventricular+capture.++Further+appropriate+clinical+trials+are+needed+to+clarify+this+issue.%0A++++++++++++In+patients+with+asymptomatic+Brugada+syndrome+who+are+family+members+of+symptomatic+Brugada+syndrome+patients%2C+the+same+strategy+as+that+for+the+symptomatic+Brugada+syndrome+patients+should+be+considered+2%2C3%2C4.++In+another+asymptomatic-patient+group+in+whom+an+ECG+that+discloses+the+Brugada+sign+is+performed+for+routine+reasons+such+as+a+workup+prior+to+surgery+or+sport+license+or+screening+for+insurance%2C+risk+stratification+to+find+the+patients+at+high+risk+is+needed+because+in+most+cases+these+patients+have+a+benign+prognosis3%2C22%2C23.++Antzelevitch+et+al.+4%2C+recommended+that+all+asymptomatic+patients+with+the+Brugada+sign+should+undergo+an+EP+study+for+risk+stratification%2C+and%2C+if+inducible%2C+an+ICD+should+be+implanted+since+Brugada+et+al.3%2C+reported+that+an+overall+8%25+life-threatening+event+rate+was+found+in+initially+asymptomatic+patients.++Belhassen+et+al.%2C13+suggested+that+EP+study-guided+quinidine+therapy+might+become+an+alternative+to+ICD+therapy+for+prophylaxis+of+arrhythmic+events+in+these+patients.+Further+appropriate+clinical+trials+are+needed.&rft.publisher=Indian+Pacing+and+Electrophysiology+Group&rft.contributor=Singh%2C+Balbir&rft.contributor=Lokhandwala%2C+Yash&rft.contributor=Francis%2C+Johnson&rft.contributor=Gupta%2C+Anup&rft.date=2004-01&rft.type=Journal+(Paginated)&rft.type=PeerReviewed&rft.format=text%2Fhtml&rft.identifier=http%3A%2F%2Fcogprints.org%2F4236%2F1%2Ftsuchiya.htm&rft.format=application%2Fpdf&rft.identifier=http%3A%2F%2Fcogprints.org%2F4236%2F2%2Ftsuchiya.pdf&rft.identifier=++Tsuchiya%2C+Takeshi++(2004)+Role+of+pharmacotherapy+in+Brugada+syndrome.++%5BJournal+(Paginated)%5D+++++&rft.relation=http%3A%2F%2Fcogprints.org%2F4236%2F