Assessment of noninvasive markers in identifying patients at risk in the Brugada syndrome: insight into risk stratification
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Since its introduction in 1992, the Brugada syndrome has attracted great interest because of increased risk of sudden cardiac death. Risk stratification aimed at the identification of patients at risk for sudden death is an important goal of current research. Controversy exists on risk stratification particularly in asymptomatic individuals. The predictive value of the inducibility of ventricular tachyarrhythmias is also discussed controversially. Currently, an implantable cardioverter defibrillator is the only proven effective treatment for the disease.
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The Brugada syndrome (BrS) is an arrhythmogenic disease associated with an increased risk of ventricular fibrillation and sudden cardiac death.The risk stratification and management of BrS patients, particularly of asymptomatic ones, still remains challenging.A previous history of aborted sudden cardiac death or arrhythmic syncope in the presence of spontaneous type 1 ECG pattern of BrS phenotype appear to be the most reliable predictors of future arrhythmic events.Several other ECG parameters have been proposed for risk stratification.Among these ECG markers, QRS-fragmentation appears very promising.Although the value of electrophysiological study still remains controversial, it appears to add important information on risk stratification, particularly when incorporated in multiparametric scores in combination with other known risk factors.The present review article provides an update on the pathophysiology, risk stratification and management of patients with BrS.www.jafib.com
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Brugada syndrome (BrS) is one of the main inherited arrhythmia syndromes causing ventricular fibrillation (VF) and sudden cardiac death in young to middle-aged men, especially in Asians. The diagnosis of BrS is based on spontaneous or drug-provoked type 1 Brugada electrocardiogram. The current reliable therapy for BrS patients with VF history is the implantation of an implantable cardioverter-defibrillator. As for BrS patients without VF history, how asymptomatic BrS patients should effectively be treated is still uncertain because risk stratification of the BrS is still inadequate. Various parameters and combinations of several parameters have been reported for risk stratification of BrS. The SCN5A gene is believed to be the only gene that is responsible for BrS, and it has been reported to be useful for risk stratification. This review focuses on risk stratification of BrS patients, and focuses specifically on BrS patients of Asian descent.
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The Brugada syndrome (BrS) is an arrhythmogenic disease associated with an increased risk of ventricular fibrillation and sudden cardiac death. The risk stratification and management of BrS patients, particularly of asymptomatic ones, still remains challenging. A previous history of aborted sudden cardiac death or arrhythmic syncope in the presence of spontaneous type 1 ECG pattern of BrS phenotype appear to be the most reliable predictors of future arrhythmic events. Several other ECG parameters have been proposed for risk stratification. Among these ECG markers, QRS-fragmentation appears very promising. Although the value of electrophysiological study still remains controversial, it appears to add important information on risk stratification, particularly when incorporated in multiparametric scores in combination with other known risk factors. The present review article provides an update on the pathophysiology, risk stratification and management of patients with BrS.
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Abstract Brugada syndrome (BS) is a cardiac disorder characterized by typical electrocardiographic findings (type 1 Brugada ECG); it is associated with a high risk for sudden cardiac death (SCD) due to ventricular fibrillation (VF). Risk stratification is still challenging, especially in cases in which a history of cardiac arrest or VF has not been documented. The role of programmed electrical stimulation (PES) for risk stratification remains controversial. In this article, I will review recent published data on the use of PES in the identification of high‐risk patients and discuss the value of PES for risk assessment in BS.
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b r t w u r t i c As with other cardiovascular diseases, advances in our understanding of the pathophysiology of acute coronary syndrome (ACS) have resulted in the use of new biomarkers (measurable plasma molecules) that reflect the different mechanisms that underlie the condition. These biomarkers are valuable tools that are increasingly used not only for early diagnosis but for shortand long-term prognostic stratification. A wide range of biomarkers are now available in ACS, including those that reflect vascular inflammation due to atherosclerotic disease (high-sensitivity C-reactive protein [CRP]), markers of protease activity associated with progression of atherosclerosis and plaque destabilization (cystatin C), and those indicating myocardial injury (troponin and ST2), renal damage (cystatin C, NGAL, glomerular filtration rate), or ventricular dysfunction (neurohormonal peptides
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