General Anesthesia Attenuates Brugada Syndrome Phenotype ExpressionClinical Implications From a Prospective Clinical Trial
Author + information
- Giuseppe Ciconte, MD, PhDa,
- Vincenzo Santinelli, MDa,
- Josep Brugada, MD, PhDb,
- Gabriele Vicedomini, MDa,
- Manuel Conti, MDa,
- Michelle M. Monasky, PhDa,
- Valeria Borrelli, BMSca,
- Walter Castracane, MDc,
- Tommaso Aloisio, MDc,
- Luigi Giannelli, MDa,
- Umberto Di Dedda, MDc,
- Paolo Pozzi, BEngd,
- Marco Ranucci, MDc and
- Carlo Pappone, MD, PhDa,∗ (carlo.pappone{at}af-ablation.org)
- aArrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- bCardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
- cDepartment of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- dJohnson & Johnson, Biosense Webster, Pomezia, Rome, Italy
- ↵∗Address for correspondence:
Dr. Carlo Pappone, Department of Arrhythmology, IRCCS Policlinico San Donato, Piazza E. Malan 1, 20097 San Donato Milanese, Milan, Italy.
Graphical abstract
Abstract
Objectives This study investigates the electrocardiographic-electrophysiological effects of administration of anesthetic drugs for general anesthesia (GA) in patients with BrS at high risk of sudden cardiac death (SCD).
Background The safety of anesthetic agents in Brugada syndrome (BrS) is under debate.
Methods All consecutive patients with spontaneous type 1 BrS electrocardiographic (ECG) patterns undergoing epicardial ablation of the arrhythmogenic substrate (AS) under GA were enrolled. Anesthesia was induced with single bolus of propofol and maintained with sevofluorane. ECG measurements were collected before, immediately after, and 20 min after induction of GA. Three-dimensional maps during GA and after ajmaline indicated the epicardial AS before ablation.
Results Thirty-six patients with BrS (32 male, 88.9%; mean age 38.8 ± 12.0 years) with a spontaneous type 1 ECG pattern underwent GA. Induction was performed using propofol at mean dose of 1.6 to 2.6 mg/kg (2.1 ± 0.3 mg/kg). Twenty-eight (28 of 36, 77.8%) patients showed a reversion to a nondiagnostic pattern. ST-segment elevation (0.32 ± 0.01 mV vs. 0.19 ± 0.02 mV; p < 0.001) and J-wave amplitude (0.47 ± 0.02 mV vs. 0.31 ± 0.03 mV; p < 0.001) decreased after propofol. The AS area during GA, in the absence of BrS pattern, significantly enlarged after administration of ajmaline (3.6 ± 0.5 cm2 vs. 20.3 ± 0.8 cm2). No patient developed malignant arrhythmias during GA induction and maintenance.
Conclusions 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)
Footnotes
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received October 18, 2017.
- Revision received November 17, 2017.
- Accepted November 23, 2017.
- 2018 American College of Cardiology Foundation
