General Anesthesia Attenuates Brugada Syndrome Phenotype Expression

Abstract

This study shows that GA using single-bolus propofol and volatile anesthetics is safe in high-risk patients with BrS, and it may exert a modulating effect by reducing the manifestation of type 1 BrS pattern and AS in the form of epicardial abnormal ECGs. (Epicardial Ablation in Brugada Syndrome: An Extension Study of 200 BrS Patients; NCT03106701).

Post-operative Brugada electrocardiographic pattern, polymorphic ventricular tachycardia, and sudden death in a child after administration of propofol anaesthesia

“…[13][14][15][16][17] Interestingly, a bolus dose of propofol has been shown to attenuate BrS-associated arrhythmogenic risk in high-risk adults with BrS patients in a recent study. 18 In contrast to adults in these studies [13][14][15][16][17][18] who did not have clinically significant symptoms following propofol administration (mean dose 2.2-3.3 mg/kg), those with propofol infusion syndrome were administered a higher dose of propofol (4.5-7.3 mg/kg/hour). 8 EKG changes in patients with BrS phenocopy due to propofol infusion syndrome have been shown to normalise as early as 24 hours after withdrawal of propofol, and provocative testing with sodium channel blockers typically does not reveal an underlying predisposition to BrS.…”

“…The dose of propofol (2 mg/kg) used in our patient is comparable to the dose utilised in adults who were administered a single propofol bolus (mean dose 2.2-3.3 mg/kg). 13,14,18 However, long-term use of antiarrhythmics such as amiodarone, β-blockers, calcium-channel blockers, and sodium channel blockers, which could have a bearing on the EKG changes and the risk of arrhythmogenesis during the procedure, was reported in one of the larger studies that found a low incidence of propofol infusion syndrome during and after short-term infusion of propofol. 13 Moreover, drug-induced BrS EKG changes can persist beyond the expected period of complete elimination of the offending drug from the body.…”

A fatal adverse event upon adenotonsillectomy in a child. Are Brugada syndrome and propofol real accomplices?

“…Nevertheless, the conclusion of "a small risk of fatal ventricular arrhythmias in the postoperative period in patients who receive propofol anaesthesia" is not confirmed by prospective clinical trials. 10,11…”

Reply to letter “A fatal adverse event upon adenotonsillectomy in a child. Are Brugada syndrome and propofol real accomplices?”

“…6,7 Of note, the electrographic findings were only assessed 3 to 20 minutes after propofol administration with the underlying assumption that hypnotic effect of propofol correlates with its cardiac effects, which may not be true. 6,7 The majority of patients in these studies were adults who are often treated with medications that have the potential to alter autonomic tone or have antiarrhythmic effects, such as beta-blockers, calcium channel blockers, digoxin, quinidine, or other antiarrhythmics to name a few. In addition, data pertaining to administration of parasympatholytic agents such as atropine prior to induction with propofol, which can modulate the expression of Brugada phenotype, were not reported.…”