+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Flecainide test in Brugada syndrome: a reproducible but risky tool

Flecainide test in Brugada syndrome: a reproducible but risky tool

Pacing and Clinical Electrophysiology 26(1p2): 338-341

The flecainide test is widely used in Brugada syndrome. However, its reproducibility and safety remain ill-defined. This study included 22 patients (18 men, mean age 34 years). Mutations in the SCN5A gene were found in eight patients. Two patients had aborted sudden cardiac death, 8 had syncope/presyncope, and 12 were asymptomatic. The ECG was diagnostic in 19 patients and suggestive in 3. At baseline, 21 of 22 patients underwent a flecainide test (2 mg/kg IV bolus over 10 minutes). In 21 of 21 patients the test was diagnostic or amplified the typical ECG pattern. At the end of drug infusion, sustained VT lasting 7-10 minutes developed in two patients. A second flecainide test was performed within 2 months in 20 patients. The test was not repeated in the two patients with prior development of VT. The flecainide test was diagnostic in 20 of 20 patients. Sustained VT occurred in one patient and recurrent VF in another. The reproducibility of the flecainide test was 100%. In 4 (18%) of 22 patients major VAs were documented after the end of flecainide infusion. VA occurred in 3 (43%) of 7 patients with, versus 1 (7%) 15 without SCN5A gene mutation (P < 0.05). No diagnostic ECG changes or arrhythmias developed in 25 control patients without structural heart disease who underwent the same study protocol. This study shows a high flecainide reproducibility, supporting its diagnostic value in Brugada syndrome. However, the occurrence of major VA, significantly higher in patients with documented SCN5A gene mutation, including in asymptomatic patients, mandates the performance under appropriate medical supervision. Whether a slower rate of drug infusion can lower the risk of VA induction, while maintaining the sensitivity of the test should be explored.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 049091022

Download citation: RISBibTeXText

PMID: 12687841

DOI: 10.1046/j.1460-9592.2003.00045.x

Related references

Flecainide test in the Brugada syndrome A reproducible but risky tool. European Heart Journal 22(Abstract Suppl.): 450, 2001

Flecainide challenge test for the diagnosis of Brugada syndrome. Postgraduate Medical Journal 80(950): 723, 2004

Late positive flecainide challenge test for Brugada syndrome. Heart Rhythm 11(5): 898-900, 2014

Flecainide test for diagnosis of Brugada syndrome Diagnostic accuracy and complications. European Heart Journal 24(Abstract Suppl.): 148, August-September, 2003

Negative flecainide test in Brugada syndrome patients with previous positive response. Europace 8(10): 899-900, 2006

Fever outperforms flecainide test in the unmasking of type 1 Brugada syndrome electrocardiogram. Europace 15(3): 394, 2013

Delayed positive response to a flecainide test in a patient with suspected Brugada syndrome: a worrisome finding. Revista Espanola de Cardiologia 67(8): 674-675, 2014

Ajmaline versus flecainide A prospective pharmacological comparision for the detection of Brugada-syndrome in patients with Brugada-like electrocardiogram changes. European Heart Journal 24(Abstract Suppl.): 148, August-September, 2003

Does a Brugada pattern ECG precipitated by excessive-dose flecainide provide a diagnosis of a Brugada syndrome patient and/or contraindicate its use? A case study. Circulation. Arrhythmia and Electrophysiology 4(4): E47-E51, 2011

Flecainide challenge test: Predictors of unmasking of type 1 Brugada ECG pattern among those with non-type 1 Brugada ECG pattern. Indian Pacing and Electrophysiology Journal 16(2): 53-58, 2016

Flecainide provocation reveals concealed brugada syndrome in a long QT syndrome family with a novel L1786Q mutation in SCN5A. Circulation Journal 78(5): 1136-1143, 2014

The elusive link between LQT3 and Brugada syndrome: the role of flecainide challenge. Circulation 102(9): 945-947, 2000

Diagnostic value of flecainide testing in unmasking SCN5A-related Brugada syndrome. Journal of Cardiovascular Electrophysiology 17(8): 857-864, 2006

Intravenous drug challenge using flecainide and ajmaline in patients with Brugada syndrome. Heart Rhythm 2(3): 254-260, 2005

Time-dependent responses to provocative testing with flecainide in the diagnosis of Brugada syndrome. Heart Rhythm 12(2): 350-357, 2015