Prevalence, Clinical Characteristics and Management of Atrial Fibrillation in Patients With Brugada Syndrome

Study Questions:

How often is the diagnosis of Brugada syndrome (BrS) preceded by clinically manifest atrial fibrillation (AF)?


A BrS database that included 611 patients was reviewed to identify patients with a documented episode of AF prior to the diagnosis of BrS.


Thirty-five patients (mean age 49 years) had a history of AF before the diagnosis of BrS. A BrS pattern on the electrocardiogram (ECG) became apparent after initiation of treatment with a class I antiarrhythmic agent in 11 patients and during general anesthesia in one patient. Among the remaining 23 patients, a BrS pattern was brought out by an ajmaline challenge performed as part of the diagnostic evaluation in 13 patients with lone AF, five patients with a family history of sudden death, three patients with syncope or aborted sudden death, and two patients with an abnormal ECG. The baseline ECG was normal in 21/35 patients (60%). Electrophysiologic testing disclosed sinus node dysfunction in six patients, right atrial flutter in four, a His-ventricular interval ≥60 ms in five, 1º atrioventricular (AV) block in two, AV reentrant tachycardia in one, and AV nodal reentrant tachycardia in one.


AF can be the first clinical manifestation of BrS. If BrS is unrecognized, treatment with a class Ic antiarrhythmic drug such as flecainide potentially could result in dangerous ventricular arrhythmias.


The prevalence of AF in the BrS has been estimated to be approximately 20%. The high prevalence of AF suggests that the sodium channel mutation that affects ventricular myocytes in BrS also affects atrial myocytes.

Clinical Topics: Arrhythmias and Clinical EP, Dyslipidemia, Heart Failure and Cardiomyopathies, Implantable Devices, EP Basic Science, Genetic Arrhythmic Conditions, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Lipid Metabolism

Keywords: Brugada Syndrome, Heart Atria, Sick Sinus Syndrome, Baroreflex, Syncope, Electrophysiologic Techniques, Cardiac, Electrocardiography, Heart Rate, Sodium Channels, Tachycardia, Mutation, Prevalence, Atrioventricular Block, Death, Muscle Cells, Flecainide, Atrial Flutter

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