Ventricular Arrhythmia Induced by Sodium Channel Blocker in Patients with Brugada Syndrome

Hiroshi Morita, Shiho Takenaka Morita, Satoshi Nagase, Kimikazu Banba, Nobuhiro Nishii, Yoshinori Tani, Atsuyuki Watanabe, Kazufumi Nakamura, Kengo Fukushima Kusano, Tetsuro Emori, Hiromi Matsubara, Kazumasa Hina, Toshimasa Kita, Tohru Ohe

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Abstract

OBJECTIVES: We administered pilsicainide chloride, a class Ic pure sodium channel blocker, to patients with Brugada syndrome (BS) and evaluated the occurrence of ventricular arrhythmia (VA) and T-wave alternans (TWA). BACKGROUND: Ventricular arrhythmia and TWA are sometimes induced by a sodium channel blocker challenge test in BS patients, but the significance of the induced VA and TWA is not known. METHODS: Pilsicainide was administered to 65 patients with BS (10 symptomatic and 55 asymptomatic patients), and the occurrence of VA, TWA, and change of electrocardiogram were evaluated. Electrophysiologic study was performed in 57 patients, and the induction of VA by programmed electrical stimulation (PES) was evaluated. RESULTS: Ventricular arrhythmia was not induced by administration of pilsicainide in 55 patients (no-VA group). Administration of pilsicainide-induced VA in 10 patients (Pil-VA group) and polymorphic ventricular tachycardia in four patients. Pilsicainide-induced VA in 60% of the symptomatic patients but in only 7% of asymptomatic patients (p <0.01). ST level, QTc, and indexes of cardiac conduction in the Pil-VA group were not different from those in the no-VA group. Ventricular fibrillation was induced by PES in 67% of the patients in the Pil-VA group and in 33% of the patients in the no-VA group. In six cases, macroscopic TWA occurred in association with pilsicainide-induced VA, but TWA occurred in only one patient without pilsicainide-induced arrhythmia. CONCLUSIONS: Administration of a sodium channel blocker results in induction of not only ST-elevation but also VA and TWA in patients with BS. (J Am Coll Cardiol 2003;42:1624-31)

Original languageEnglish
Pages (from-to)1624-1631
Number of pages8
JournalJournal of the American College of Cardiology
Volume42
Issue number9
DOIs
Publication statusPublished - Nov 5 2003

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Sodium Channel Blockers
Brugada Syndrome
Cardiac Arrhythmias
Electric Stimulation

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  • Nursing(all)

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Ventricular Arrhythmia Induced by Sodium Channel Blocker in Patients with Brugada Syndrome. / Morita, Hiroshi; Morita, Shiho Takenaka; Nagase, Satoshi; Banba, Kimikazu; Nishii, Nobuhiro; Tani, Yoshinori; Watanabe, Atsuyuki; Nakamura, Kazufumi; Kusano, Kengo Fukushima; Emori, Tetsuro; Matsubara, Hiromi; Hina, Kazumasa; Kita, Toshimasa; Ohe, Tohru.

In: Journal of the American College of Cardiology, Vol. 42, No. 9, 05.11.2003, p. 1624-1631.

Research output: Contribution to journalArticle

Morita, H, Morita, ST, Nagase, S, Banba, K, Nishii, N, Tani, Y, Watanabe, A, Nakamura, K, Kusano, KF, Emori, T, Matsubara, H, Hina, K, Kita, T & Ohe, T 2003, 'Ventricular Arrhythmia Induced by Sodium Channel Blocker in Patients with Brugada Syndrome', Journal of the American College of Cardiology, vol. 42, no. 9, pp. 1624-1631. https://doi.org/10.1016/j.jacc.2003.06.004
Morita, Hiroshi ; Morita, Shiho Takenaka ; Nagase, Satoshi ; Banba, Kimikazu ; Nishii, Nobuhiro ; Tani, Yoshinori ; Watanabe, Atsuyuki ; Nakamura, Kazufumi ; Kusano, Kengo Fukushima ; Emori, Tetsuro ; Matsubara, Hiromi ; Hina, Kazumasa ; Kita, Toshimasa ; Ohe, Tohru. / Ventricular Arrhythmia Induced by Sodium Channel Blocker in Patients with Brugada Syndrome. In: Journal of the American College of Cardiology. 2003 ; Vol. 42, No. 9. pp. 1624-1631.
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abstract = "OBJECTIVES: We administered pilsicainide chloride, a class Ic pure sodium channel blocker, to patients with Brugada syndrome (BS) and evaluated the occurrence of ventricular arrhythmia (VA) and T-wave alternans (TWA). BACKGROUND: Ventricular arrhythmia and TWA are sometimes induced by a sodium channel blocker challenge test in BS patients, but the significance of the induced VA and TWA is not known. METHODS: Pilsicainide was administered to 65 patients with BS (10 symptomatic and 55 asymptomatic patients), and the occurrence of VA, TWA, and change of electrocardiogram were evaluated. Electrophysiologic study was performed in 57 patients, and the induction of VA by programmed electrical stimulation (PES) was evaluated. RESULTS: Ventricular arrhythmia was not induced by administration of pilsicainide in 55 patients (no-VA group). Administration of pilsicainide-induced VA in 10 patients (Pil-VA group) and polymorphic ventricular tachycardia in four patients. Pilsicainide-induced VA in 60{\%} of the symptomatic patients but in only 7{\%} of asymptomatic patients (p <0.01). ST level, QTc, and indexes of cardiac conduction in the Pil-VA group were not different from those in the no-VA group. Ventricular fibrillation was induced by PES in 67{\%} of the patients in the Pil-VA group and in 33{\%} of the patients in the no-VA group. In six cases, macroscopic TWA occurred in association with pilsicainide-induced VA, but TWA occurred in only one patient without pilsicainide-induced arrhythmia. CONCLUSIONS: Administration of a sodium channel blocker results in induction of not only ST-elevation but also VA and TWA in patients with BS. (J Am Coll Cardiol 2003;42:1624-31)",
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T1 - Ventricular Arrhythmia Induced by Sodium Channel Blocker in Patients with Brugada Syndrome

AU - Morita, Hiroshi

AU - Morita, Shiho Takenaka

AU - Nagase, Satoshi

AU - Banba, Kimikazu

AU - Nishii, Nobuhiro

AU - Tani, Yoshinori

AU - Watanabe, Atsuyuki

AU - Nakamura, Kazufumi

AU - Kusano, Kengo Fukushima

AU - Emori, Tetsuro

AU - Matsubara, Hiromi

AU - Hina, Kazumasa

AU - Kita, Toshimasa

AU - Ohe, Tohru

PY - 2003/11/5

Y1 - 2003/11/5

N2 - OBJECTIVES: We administered pilsicainide chloride, a class Ic pure sodium channel blocker, to patients with Brugada syndrome (BS) and evaluated the occurrence of ventricular arrhythmia (VA) and T-wave alternans (TWA). BACKGROUND: Ventricular arrhythmia and TWA are sometimes induced by a sodium channel blocker challenge test in BS patients, but the significance of the induced VA and TWA is not known. METHODS: Pilsicainide was administered to 65 patients with BS (10 symptomatic and 55 asymptomatic patients), and the occurrence of VA, TWA, and change of electrocardiogram were evaluated. Electrophysiologic study was performed in 57 patients, and the induction of VA by programmed electrical stimulation (PES) was evaluated. RESULTS: Ventricular arrhythmia was not induced by administration of pilsicainide in 55 patients (no-VA group). Administration of pilsicainide-induced VA in 10 patients (Pil-VA group) and polymorphic ventricular tachycardia in four patients. Pilsicainide-induced VA in 60% of the symptomatic patients but in only 7% of asymptomatic patients (p <0.01). ST level, QTc, and indexes of cardiac conduction in the Pil-VA group were not different from those in the no-VA group. Ventricular fibrillation was induced by PES in 67% of the patients in the Pil-VA group and in 33% of the patients in the no-VA group. In six cases, macroscopic TWA occurred in association with pilsicainide-induced VA, but TWA occurred in only one patient without pilsicainide-induced arrhythmia. CONCLUSIONS: Administration of a sodium channel blocker results in induction of not only ST-elevation but also VA and TWA in patients with BS. (J Am Coll Cardiol 2003;42:1624-31)

AB - OBJECTIVES: We administered pilsicainide chloride, a class Ic pure sodium channel blocker, to patients with Brugada syndrome (BS) and evaluated the occurrence of ventricular arrhythmia (VA) and T-wave alternans (TWA). BACKGROUND: Ventricular arrhythmia and TWA are sometimes induced by a sodium channel blocker challenge test in BS patients, but the significance of the induced VA and TWA is not known. METHODS: Pilsicainide was administered to 65 patients with BS (10 symptomatic and 55 asymptomatic patients), and the occurrence of VA, TWA, and change of electrocardiogram were evaluated. Electrophysiologic study was performed in 57 patients, and the induction of VA by programmed electrical stimulation (PES) was evaluated. RESULTS: Ventricular arrhythmia was not induced by administration of pilsicainide in 55 patients (no-VA group). Administration of pilsicainide-induced VA in 10 patients (Pil-VA group) and polymorphic ventricular tachycardia in four patients. Pilsicainide-induced VA in 60% of the symptomatic patients but in only 7% of asymptomatic patients (p <0.01). ST level, QTc, and indexes of cardiac conduction in the Pil-VA group were not different from those in the no-VA group. Ventricular fibrillation was induced by PES in 67% of the patients in the Pil-VA group and in 33% of the patients in the no-VA group. In six cases, macroscopic TWA occurred in association with pilsicainide-induced VA, but TWA occurred in only one patient without pilsicainide-induced arrhythmia. CONCLUSIONS: Administration of a sodium channel blocker results in induction of not only ST-elevation but also VA and TWA in patients with BS. (J Am Coll Cardiol 2003;42:1624-31)

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