Şerafettin DEMİR, Mücahit TÜFENK, Vedat Davutoğlu, Mehmet Kanadaşı, Zeynep KARAKAYA

Sodyum Kanal Blokeri ile Ortaya Çıkarılan Brugada Sendromu

Giriş: Brugada sendromu yapısal olarak normal kalpte sağ prekordiyal elektrokardiyografi (EKG) leadlerde ST segment elevasyonu ve artmış ani kardiyak ölüm riski ile karakterizedir. Klinik olarak atipik göğüs ağrısı, çarpıntı, senkop, supraventriküler taşikardi,ventriküler taşikardi, ventriküler fibrilasyon, ani ölüm şeklinde karşılaşılabilir. Olgu Sunumu: Otuz dokuz yaşında erkek hasta çarpıntı, presenkop şikayeti ile kliniğimize başvurdu. Presenkop, ailede ani ölüm öyküsü ve EKG bulguları bir arada değerlendirilen hastada ön tanı olarak brugada sendromu düşünüldü. Tanıyı doğrulamak için hastaya ajmanil verilerek provakasyon testi uygulandı. Seri çekilen EKG’lerini değerlendirildi ve hastada Brugada sendromu tanısını doğrulayan Tip 1 EKG örneği gözlendi. Sonuç: Amacımız Brugada sendromu düşünülen vakalarda tanı koymaya yardımcı bir yöntem olan sodyum kanal blokerlerinin kullanımını, vaka üzerinden tartışmak ve tanı kolaylığı sağlayacak yöntemi tanıtmaktır.

Anahtar Kelimeler:

Brugada sendromu, ani kardiyak ölüm, ajmaline

Brugada Syndrome was Uncovered with a Sodium Channel Blocker

Introduction: The Brugada syndrome is characterized by an STsegment elevation in the right precordial electrocardiography (ECG) leads and a high incidence of sudden death in patients with structurally normal hearts. Clinically, atypical chest pain, palpitations, syncope, supraventricular tachycardia, ventricular tachycardia, ventricular fibrillation and sudden death may occur. Case Report: A 39 year old male patient was admitted with presyncope and palpitation symptoms to our clinic. A family history of sudden death presyncope and ECG findings brought the Brugada syndrome as a differential diagnosis to mind. To confirm the diagnosis, a provacation test with ajmanil was done. Serial performed ECGs have been evaluated and a Type 1 ECG sample which confirms the Brugada Syndrome has been observed in the patient.Conclusion: Our goal is to help make the diagnosis of Brugada syndrome cases, a method comprising the use of the sodium channel blockers, and discuss case studies to introduce the method to provide ease of diagnosis

Keywords:

Brugada syndrome, sudden cardiac death, ajmaline,

PDF

___

Brugada P, Brugada J. Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocar- diographic syndrome. A multicenter report. J Am Coll Cardiol 1992; 20: 1391-6.
Antzelevitch C, Brugada P, Brugada J, Brugada R, Towbin JA, Nadema- nee K. Brugada syndrome: 1992-2002: A historical perspective. J Am Coll Cardiol 2003; 41: 1665-71.
Akdemir İ, Davutoğlu V, Dinckal MH, Aksoy M. Akut myokard infarktüsü tanısı ile karıştırılan bir brugada sendromu olgusu. Turk Kardiyol Dern Arş 2001; 29: 723-6.
Brugada J, Brugada R, Brugada P. Right bundle-branch block and ST- segment elevation in leads V1 through V3: A marker for sudden death in patients without demonstrable structural heart disease. Circulation 1998; 97: 457-60.
Wilde AA, Antzelevitch C, Borggrefe M, Brugada J, Brugada R, Brugada P, et al. Proposed diagnostic criteria for the Brugada syndrome. Eur Heart J 2002; 23: 1648-54.
Wilde AA, Antzelevitch C, Borggrefe M, Brugada J, Brugada R, Brugada P, et al. Proposed diagnostic criteria for the Brugada syndrome: Consen- sus report. Circulation 2002; 106: 2514-9.
Morita H, Kusano-Fukushima K, Nagase S, Fujimoto Y, Hisamatsu K, Fujio H, et al. Atrial fibrillation and atrial vulnerability in patients with Brugada syndrome. J Am Coll Cardiol 2002; 40: 1437-44.
Gussak I, Bjerregaard P, Hammill SC. Clinical diagnosis and risk stratifica- tion in patients with Brugada syndrome. J Am Coll Cardiol 2001; 37: 1635-8.
Tatli E, Gul C, Surucu H, Ozcelik F. Brugada syndrome: Clinical evaluation, diagnosis and treatment modalities: Reiew. Turkiye Klinikleri J Med Sci 2005; 25: 560-4.
Brugada J, Brugada R, Brugada P. Right bundle-branch block and ST- segment elevation in leads V1 through V3: a marker for sudden death in patients without demonstrable structural heart disease. Circulation 1998; 97: 457-60.
Brugada R, Brugada J, Antzelevitch C, Kirsch GE, Potenza D, Towbin JA, et al. Sodium channel blokers identfy risk for sudden death in patients with ST segment elevation and right bundle branch block but structur- ally normal hearts. Circulation 2000; 101: 510-5.
Demirtaş S, Atar İ, Köse S. Ajmalin testi. Türk Aritmi Pacemaker ve Elek- trofizyoloji Dergisi 2008; 6: 1.
Rolf S, Bruns HJ, Wichter T, Kirchhof P, Ribbing M, Wasmer K, et al. The aj- maline challenge in Brugada syndrome: Diagnostic impact, safety, and recommended protocol. Eur Heart J 2003; 24: 1104-12.