Brugada症候群の取り扱い : Brugada型心電図をどう管理するか

Brugada et al . reported that electrocardiogaraphic finding of ST elevation and right bundle branch block in the right precordial lead are closely associated with cardiac sudden death during sleep in 1992, and these finding is an important substrate of idiopathic ventricular fibrillation, since then we became call this clinical condition Brugada syndrome. Brugada type ECG is not so rare abnormality in Japan, especially saddle-back type ST elevation is often encountered in mass examination or daily clinic, and lethal arrhythmias are occurred in these some cases. Several percentage of asymptomatic Brugada syndrome complicate sudden cardiac death. Therefore, diagnosis and evaluation of prognosis of Brugada type ECG become important issue for daily clinic. Various suggestions for Brugada syndrome and asymptomatic Brugada type ECG are proposed, and implantable cardioverter defibrillator （ICD） is only therapy for Brugada syndrome, but there is not yet an agreed opinion about management of Brugada type ECG. Appropriate prevention for sudden death is necessary since some asymptomatic cases with Brugada type ECG complicate ventricular fibrillation. In our daily clinic, we examine signal averaged ECG, 123I-MIBG myocardial scintigarphy and adoministration test of pilsicanide for the case with Brugada type ECG as a screening test, and perform foreknowledge of sudden death. In near future, the standardized screening test for asymptomatic Brugada type ECG will be established by further study.

四国医学雑誌 : http://www.tokushima-u.ac.jp/med/research/shikoku_acta_medica.html