Propofol for implantable cardioverter defibrillator implantation in patients with Brugada syndrome

Abstract

ICD implantation without significant ECG changes or adverse outcomes is feasible under propofol sedation in patients with Brugada syndrome. However, because of significant hemodynamic changes and respiratory compromise, close monitoring and meticulous propofol dose titration is warranted.

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

“…12 Recent studies have found lower incidence of ventricular arrhythmias following administration of a single dose of propofol in an unselected cohort as well as adults with BrS. [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).…”

“…[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.…”

Vitreoretinal Surgery Under Sub-Tenon’s Block and Conscious Sedation in a Patient with Brugada Syndrome: A Case Report and Literature Review

“…It has been suggested that propofol should be avoided in patients with BrS due to its arrhythmogenic potential ( 4 ). However, it has been safely used for sedation during the implantation of an ICD ( 24 ). In our case, low-dose propofol was successfully used when the patient became a little restless halfway through surgery.…”

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

“…2 It remains unclear whether propofol and/or one of its metabolites is responsible for the reported adverse cardiac electrical effects. Moreover, cardiac electrical abnormalities have persisted well beyond the expected duration of effect for propofol, 3,4 and complete elimination period for several other drugs 5 suggesting permanent disruption of relevant ion channels or downstream proteins could underlie this observation.…”