Completely New Angle On Reelin Just Unveiled

In early studies, BrS patients with signs of early repolarization show a more severe phenotype and a considerably increased risk of VF, respectively (30�C 33). In addition, there is an increased risk of an ��electrical storm�� (��3 VT/VF episodes within 24 hours) if additional signs of ER are present (33, 34). Patients with right precordial fQRS and inferolateral ER appear to have a particularly high risk of VF (30). Figure 7 Early repolarization pattern in the form of QRS ��slurring�� In two studies, paroxysmal atrial fibrillation was associated with more frequent syncope and/or ventricular fibrillation (e7, e8). Not relevant to risk stratification According to the study results (10, 22, e49), a family history of sudden cardiac death or the presence of a SCN5A mutation has no prognostic impact and is therefore currently not included in risk stratification (5, 6). Treatment Implantable cardioverter�Cdefibrillator In symptomatic BrS patients (aborted sudden cardiac death, documented VT with or without syncope), implantation of an ICD is clearly indicated (class I recommendation) (5, 6) (Figure 5). Because of the high risk of ventricular arrhythmias, ICD implantation is also indicated in symptomatic BrS patients with selleck kinase inhibitor arrhythmic syncope and a spontaneous type 1 ECG (class IIa recommendation) (5�C 6, 35) (Figure 5). ICD implantation is the only treatment shown in studies to be effective in preventing sudden cardiac death in BrS patients (7). To avoid inappropriate ICD shocks, a single VF detection zone with a long detection time can be programmed (7, e50). The role of the subcutaneous ICD (S-ICD) is about to be evaluated in a multicenter study (S-ICD Brugada; NCT02344277). For asymptomatic BrS patients, individual risk assessment including consideration of other risk factors (age, sex, baseline ECG, and inducibility) is recommended (5, 6). Because of the very low risk of ventricular arrhythmias in asymptomatic BrS patients (10) without spontaneous type I ECG (19), primary prophylactic ICD implantation on the basis of only a drug-induced type I ECG and a positive family history of sudden cardiac death is currently not recommended (class III recommendation) (5, 6) (Figure 5). It is important to realize that these recommendations represent a snapshot and that the current follow-up times do not allow any definite conclusions about the long-term risk in this patient group (e51). The most recent data from the Brugada registry show for example VT/VF-related ICD shocks in 13% of initially asymptomatic patients with BrS (mean follow-up: 7 years) (e41). General therapeutic measures In patients with BrS, many substances in addition to class IC antiarrhythmics can have a proarrhythmic effect and need to be avoided. These include certain beta-blockers, various psychoactive and anesthetic drugs, antihistamines, cocaine, and alcohol consumed in excessive quantities.