Ajmaline-induced Epsilon wave: as a potential interim risk factor between the spontaneous and drug-induced type 1 Brugada electrogram? — Authors’ reply

We really appreciate the interest shown by Araset al. in our article entitled ‘The prognostic impact of single extra-stimulus on programmed ventricular stimulation in Brugada patients without previous cardiac arrest: multi-centre study in Japan’. Management of asymptomatic Brugada individuals remains the most controversial issue. Recently, Moritaet al.1 stressed that the fragmented QRS is a marker of conduction abnormality and a predictor of prognosis of Brugada syndrome (BrS), even in asymptomatic patients.2 In their letter,3 they propose the importance of drug-induced fragmented QRS for unmasking not only type 1 ST-elevation in diagnosis but also concealed electrocardiographic slow conduction features. Therefore, drug-induced fragmentation might be considered as an interim risk stratification tool in asymptomatic patients with BrS between the spontaneous and drug-induced type 1 electrocardiogram (ECG). However, the importance of drug-induced fragmented QRS in patients with a drug-induced BrS type 1 ECG is still unclear. It might be possible to play an any role in risk stratification of asymptomatic BrS patients with a drug-induced BrS type 1 ECG, but the incidence of cardiac events (sudden cardiac death or ventricular fibrillation) in these patients is quite low (0.35% per year).4 In our series of patients, all patients with cardiac events in asymptomatic individuals showed spontaneous type 1 ECG but not in drug-induced type 1 ECG.5 Therefore, at this time, we think oth...
Source: Europace - Category: Cardiology Source Type: research