Brugada综合征的氟氯胺试验:可重复但有风险的工具。

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Gasparini M, Priori SG, Mantica M, Napolitano C, Galimberti P, Ceriotti C, Simonini S

Brugada综合征的氟氯胺试验:可重复但有风险的工具。

心脏起搏临床电生理杂志。2003;26(1):338-41。

PubMed ID

12687841 (PubMed视图

]

摘要

氟氯胺试验广泛用于Brugada综合征。然而，其可重复性和安全性仍不明确。本研究纳入22例患者(男性18例，平均年龄34岁)。在8例患者中发现了SCN5A基因突变。2例心源性猝死流产，8例晕厥/晕厥前期，12例无症状。心电图诊断19例，提示3例。在基线时，22例患者中有21例接受了氟氯胺试验(2 mg/kg静脉注射，持续10分钟)。21例患者中有21例该试验可用于诊断或放大典型心电图模式。在药物输注结束时，2例患者出现持续7-10分钟的室速。在2个月内对20例患者进行了第二次氟氯胺试验。 The test was not repeated in the two patients with prior development of VT. The flecainide test was diagnostic in 20 of 20 patients. Sustained VT occurred in one patient and recurrent VF in another. The reproducibility of the flecainide test was 100%. In 4 (18%) of 22 patients major VAs were documented after the end of flecainide infusion. VA occurred in 3 (43%) of 7 patients with, versus 1 (7%) 15 without SCN5A gene mutation (P < 0.05). No diagnostic ECG changes or arrhythmias developed in 25 control patients without structural heart disease who underwent the same study protocol. This study shows a high flecainide reproducibility, supporting its diagnostic value in Brugada syndrome. However, the occurrence of major VA, significantly higher in patients with documented SCN5A gene mutation, including in asymptomatic patients, mandates the performance under appropriate medical supervision. Whether a slower rate of drug infusion can lower the risk of VA induction, while maintaining the sensitivity of the test should be explored.

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