Ask an Expert

Please enter your login and password here

Send

Fellowship

Please enter your login and password here

Submit

Journal Scan

Time-dependent responses to provocative testing with flecainide in the diagnosis of Brugada syndrome.


Heart Rhythm. 2015 Feb;12(2):350-7.

Time-dependent responses to provocative testing with flecainide in the diagnosis of Brugada syndrome.

Calvo D1Rubín JM2Pérez D2Gómez J3Flórez JP2Avanzas P4García-Ruíz JM4de la Hera JM5Reguero J4Coto E3Morís C4.

BACKGROUND:

Time-dependent variability of electrocardiogram (ECG) in patients with Brugada syndrome could affect the interpretation ofprovocative testing.

OBJECTIVE:

The aim of this study was to characterize ECG changes during and after flecainide infusion.

METHODS:

We studied 59 consecutive patients. The ECG was continuously analyzed during the first 30 minutes of provocative testing, and a single ECG was recorded 60 minutes later. We analyzed CYP2D6 and CYP3A5 variants affecting flecainide metabolism and performed blinded measurements at lead II.

RESULTS:

At baseline, ECG patterns were classified as follows: type II in 31 patients (53%), type III in 15 (25%), and normal ECG in 13 (22%). Because of induction of type I ECG, the percentage of responders progressively increased with longer recording time periods (6.8% in 10 minutes vs 11.9% in 20-30 minutes vs 18.6% in 90 minutes; P < .01). Four patients displayed a late response, which was evidenced 90 minutes after the initiation of provocative testing. QRS width differentially increased between responders and nonresponders (P < .01), with a maximum QRS width of 110 ms during the first 30 minutes being effective for identifying possible late responders (sensitivity 100%; specificity 85.6%; positive predictive value 88%; negative predictive value 100%). The incidence of CYP2D6 variants was lower in late responders than in early or delayed responders (0% vs 75% vs 100%; P = .04), while a homogeneous distribution of CYP3A5*3/*3 was observed in our population.

CONCLUSION:

Response to flecainide exhibits time-dependent variability of ECG patterns and intervals. Longer periods of ECG recording increase the recognition probability of type I ECG.

Videos

MEMBERSHIP CATEGORIES AND GUIDELINES

  • Members - Full time life members with voting rights: All those with DM/DNB cardiology qualification or equivalent and interest in arrhythmia/EP : Fees Rs 10,000.
  • Associate Members - DM/DNB/Fellows during training period. Fees Rs 3,000. No voting rights.
  • International Members: Overseas doctors with appropriate qualification and interest in arrhythmias. No voting rights. Fees 300$.
  • Industry members: Industry personnel associated with arrhythmology can become members. Membership is non-transferable. No voting rights. Fees 25,0000.
  • Any Associate Members who become eligible for Full time life membership (on completion of training period), need to pay only the balance of Rs 7,000 (10,000 - 3,000) if this is one within 1 year after completion of training. If the application for Full time life membership is received after expiry of one year of their entry as Associate Members, the full fees (viz Rs 10,000) shall apply.
  • Membership application need to be endorsed by two IHRS Members.
  • The application forms received by the office of Vice President, IHRS would need to be finally approved by the credentialing Committee (comprising of President, Secretary and Joint Secretary, IHRS).

Please print this form and send appropriate DD/Cheque in favour of Indian Heart Rhythm Society, and send through post to the following Address:

Dr Anil Saxena
Director, Cardiac Pacing & Electrophysiology
Fortis Escorts Heart Institute
Okhla Road, New Delhi, 110025 INDIA
Vice President, Indian Heart Rhythm Society
Mobile: +91 9810025511
Email: anil.saxena@hotmail.com
Secretary: +91 9910665566 (Ms Kumkum Sharma)