Efficacy of quinidine in high-risk patients with Brugada syndrome.
BACKGROUND
Automatic implantable cardioverter-defibrillator therapy is considered the only effective treatment for high-risk patients with Brugada syndrome. Quinidine depresses I(to) current, which may play an important role in the arrhythmogenesis of this disease.


RESULTS
The effects of quinidine bisulfate (mean dose, 1483+/-240 mg) on the prevention of inducible and spontaneous ventricular fibrillation (VF) were prospectively evaluated in 25 patients (24 men, 1 woman; age, 19 to 80 years) with Brugada syndrome. There were 15 symptomatic patients (including 7 cardiac arrest survivors and 7 patients with unexplained syncope) and 10 asymptomatic patients. All 25 patients had inducible VF at baseline electrophysiological study. Quinidine prevented VF induction in 22 of the 25 patients (88%). After a follow-up period of 6 months to 22.2 years, all patients are alive. Nineteen patients were treated with quinidine for 6 to 219 months (mean+/-SD, 56+/-67 months). None had an arrhythmic event, although 2 had non-arrhythmia-related syncope. Administration of quinidine was associated with a 36% incidence of side effects that resolved after drug discontinuation.


CONCLUSIONS
Quinidine effectively prevents VF induction in patients with Brugada syndrome. Our data suggest that quinidine also suppresses spontaneous arrhythmias and could prove to be a safe alternative to automatic implantable cardioverter-defibrillator therapy for a substantial proportion of patients with Brugada syndrome. Randomized studies comparing these two therapies seem warranted.
Belhassen
Bernard
B
Department of Cardiology, Tel-Aviv Sourasky Medical Center, and Tel-Aviv University, Sackler School of Medicine, Weizman St 6, Tel-Aviv 64239 Israel. bblhass@tasmc.health.gov.il
Glick
Aharon
A
Viskin
Sami
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D002304:Cardiac Pacing, Artificial; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable; D004341:Drug Evaluation; D004554:Electric Countershock; D004562:Electrocardiography; D005260:Female; D005424:Flecainide; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D026902:Potassium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use*; D024642:Potassium Channels, Voltage-Gated / Q000187:drug effects* / Q000502:physiology; D011446:Prospective Studies; D011802:Quinidine / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D012189:Retrospective Studies; D012306:Risk; D051672:Shal Potassium Channels; D013577:Syndrome; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000235:genetics / Q000517:prevention & control* / Q000628:therapy
D000889:Anti-Arrhythmia Agents; D026902:Potassium Channel Blockers; D024642:Potassium Channels, Voltage-Gated; D051672:Shal Potassium Channels; C009764:quinidine bisulfate; D011802:Quinidine; D005424:Flecainide