title: Novel Therapeutic Strategies for the Management of Ventricular Arrhythmias Associated with the Brugada Syndrome.
abstract: BACKGROUND
  Brugada syndrome (BrS) is an inherited cardiac arrhythmia syndrome characterized by prominent J waves appearing as distinct coved type ST segment elevation in the right precordial leads of the ECG. It is associated with a high risk for sudden cardiac death.
  
  
  METHODS
  We discuss 1) ECG manifestations of BrS which can be unmasked or aggravated by sodium channel blockers, febrile states, vagotonic agents, as well as tricyclic and tetracyclic antidepressants; 2) Genetic basis of BrS; 3) Ionic and cellular mechanisms underlying BrS; 4) Therapy involving devices including an implantable cardioverter defibrillator (ICD); 5) Therapy involving radiofrequency ablation; and 6) Therapy involving pharmacological therapy which is aimed at producing an inward shift in the balance of the currents active during phase 1 of the right ventricular action potential either by boosting calcium channel current (isoproterenol, cilostazol and milrinone) or by inhibition of transient outward current Ito(quinidine, bepridil and the Chinese herb extract Wenxin Keli).
  
  
  CONCLUSIONS
  This review provides an overview of the clinical and molecular aspects of BrS with a focus on approaches to therapy. Available data suggest that agents capable of inhibiting the transient outward current Itocan exert an ameliorative effect regardless of the underlying cause.
authors: Department of Pharmacology & Pharmacotherapy, University of Szeged, Szeged, Hungary.
authors: Bence
authors: B
authors: Patocskai
authors: SUNY Upstate Medical University, Syracuse, NY 13210.
authors: Charles
authors: C
authors: Antzelevitch