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Sodium channel blocker challenge in Brugada syndrome: Role in risk stratification
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International audience. We are grateful to Doctor Ozeke et al. for their interest in our study [1]. Drug-induced Brugada syndrome (BrS) is associated with a relatively low risk of arrhythmic event estimated from 0.4 to 3.7% per year [2]. As suggested by Doctor Ozeke, the main challenge remains the risk stratification of intermediate risk patients that may involve conduction parameters during sodium channel blocker challenge (SCBC). Baseline conduction disturbance in the right ventricular outflow tract [3] or atrio-ventricular block (AVB) [4] has been suggested to increase the risk of SCD but has not been confirmed for now. In our study [1], the false negative case (Fig. 1) presented a first-degree AVB during ajmaline test. Further analysis of ECG parameters during SCBC have demonstrated that patients with a positive SCBC presented at baseline and at the end of SCBC a longer P wave, PR interval in lead V 1 as well as a longer QRS interval [5]. However, occurrence of arrhythmic events was not predicted by conduction parameters (p N 0,05). Of note, only eleven patients experienced an arrhythmic event during the follow-up. Although there is a need to increase accuracy of risk stratification in intermediate risk patients, the low prevalence of ar-rhythmic event is a strong limiting factor. Whiting this context, we consider that, for now, the main interest of SCBC remains to identify, with a reliable sensitivity, pre-symptomatic relatives who may present a higher risk of SCD and perhaps the family members not affected by the Brs. Conflict of interest The authors report no relationships that could be construed as a conflict of interest. Transparency document The Transparency document associated with this article can be found, in online version. References [1]
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