%A Takeshi Tsuchiya %J Indian Pacing and Electrophysiology Journal %T Role of pharmacotherapy in Brugada syndrome %X In patients who undergo aborted sudden cardiac death or syncope of unknown origin (symptomatic Brugada syndrome), 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, 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. As mentioned above, Belhassen et al. 11, performed EP-guided medical therapy in 34 patients with idiopathic VF, in 5 of whom the criterion of Brugada syndrome were fulfilled, 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, there, however, 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, whereas the prognostic value of the EP study in predicting life-threatening events in Brugada syndrome is still controversial. Brugada et al., 3 suggested that among the asymptomatic patients, the inducibility of VT during the EP study might be a prognostic marker of risk. Studies by Priori et al., 22 and Kanda et al., 23 failed to find an association between the inducibility and recurrence of VT/VF in patients with Brugada syndrome regardless of whether it was symptomatic or asymptomatic. As Belhassen suggested 13, the difference might be due to the VF induction protocol in the EP study, in which Belhassen et al., 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. In patients with asymptomatic Brugada syndrome who are family members of symptomatic Brugada syndrome patients, the same strategy as that for the symptomatic Brugada syndrome patients should be considered 2,3,4. 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, risk stratification to find the patients at high risk is needed because in most cases these patients have a benign prognosis3,22,23. Antzelevitch et al. 4, recommended that all asymptomatic patients with the Brugada sign should undergo an EP study for risk stratification, and, if inducible, an ICD should be implanted since Brugada et al.3, reported that an overall 8% life-threatening event rate was found in initially asymptomatic patients. Belhassen et al.,13 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. %N 1 %K brugada syndrome; pharmacotherapy %P 26-32 %E Balbir Singh %E Yash Lokhandwala %E Johnson Francis %E Anup Gupta %V 4 %D 2004 %I Indian Pacing and Electrophysiology Group %L cogprints4236