Brugada Syndrome

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What is Brugada syndrome?

Brugada syndrome is a condition that causes a disruption of the heart's normal rhythm. Specifically, this disorder can lead to uncoordinated electrical activity in the heart's lower chambers (ventricles), an abnormality called ventricular arrhythmia. If untreated, the irregular heartbeats can cause fainting (syncope), seizures, difficulty breathing, or sudden death. These complications typically occur when an affected person is resting or asleep.

Brugada syndrome usually becomes apparent in adulthood, although signs and symptoms, including sudden death, can occur any time from early infancy to old age. The mean age of sudden death is approximately 40 years. This condition may explain some cases of sudden infant death syndrome (SIDS), which is a major cause of death in babies younger than one year. It is characterized by sudden and unexplained death, usually during sleep.

Sudden unexplained nocturnal death syndrome (SUNDS) is a condition characterized by unexpected cardiac arrest in young adults, usually at night during sleep. This condition was originally described in Southeast Asian populations, where it is a major cause of death. Researchers have determined that SUNDS and Brugada syndrome are the same disorder.

How common is Brugada syndrome?

The exact prevalence of Brugada syndrome is unknown, although it is estimated to affect 5 in 10,000 people worldwide. This condition occurs much more frequently in people of Asian ancestry, particularly in Japanese and Southeast Asian populations.

Although Brugada syndrome affects both men and women, the condition appears to be 8 to 10 times more common in men. Researchers suspect that testosterone, a sex hormone present at much higher levels in men, may be responsible for this difference.

What genes are related to Brugada syndrome?

Mutations in the SCN5A gene cause Brugada syndrome.

Mutations in the SCN5A gene have been identified in fewer than one-third of people with Brugada syndrome. This gene provides instructions for making a sodium channel, which normally transports positively charged sodium atoms (ions) into heart muscle cells. This type of ion channel plays a critical role in maintaining the heart's normal rhythm. Mutations in the SCN5A gene alter the structure or function of the channel, which reduces the flow of sodium ions into cells. A disruption in ion transport alters the way the heart beats, leading to the abnormal heart rhythm characteristic of Brugada syndrome.

In affected people without an identified SCN5A mutation, the cause of Brugada syndrome is often unknown. In some cases, certain drugs may cause a nongenetic (acquired) form of the disorder. Drugs that can induce an altered heart rhythm include medications used to treat some forms of arrhythmia, a condition called angina (which causes chest pain), high blood pressure, depression, and other mental illnesses. Abnormally high blood levels of calcium (hypercalcemia) or potassium (hyperkalemia), as well as unusually low potassium levels (hypokalemia), also have been associated with acquired Brugada syndrome. In addition to causing a nongenetic form of this disorder, these factors may trigger symptoms in people with an underlying SCN5A mutation.

How do people inherit Brugada syndrome?

This condition is inherited in an autosomal dominant pattern, which means one copy of the altered gene in each cell is sufficient to cause the disorder. In most cases, an affected person has one parent with the condition. Other cases may result from new mutations in the gene. These cases occur in people with no history of the disorder in their family.

Source: National Institutes of Health

Reports from University of Oulu, Division of Cardiology add new data to research in atrial fibrillation

"The prevalence of saddleback ST-elevation was higher in the lone AF group than the control group (10 vs. 0.4%, p<0.001). None had a coved-type ST-elevation in baseline ECG or during drug challenge with ajmaline or flecainide (n=13), a family history of sudden cardiac death, ventricular tachyarrhythmias, syncope, or any other features diagnostic to the Brugada syndrome. Familial clustering of lone AF (i.e. AF in >30% of first-degree relatives) was more common among the subjects with saddleback ST-elevation (24 vs. 7%, p=0.03). Saddleback-type ST-segment elevation is a relatively common finding among patients with lone AF," wrote M.J. Junttila and colleagues, University of Oulu, Division of Cardiology.

The researchers concluded: "The familial clustering of the disorder indicates that genetic factors may be involved in the pathogenesis of the ECG abnormality and lone AF in these patients."

Junttila and colleagues published the results of their research in European Heart Journal (Familial clustering of lone atrial fibrillation in patients with saddleback-type ST-segment elevation in right precordial leads. European Heart Journal, 2007;28(4):463-8).

For additional information, contact M.J. Junttila, University of Oulu, University of Oulu, Division of Cardiology, PO Box 5000, Oulu 90014, Finland.

The publisher of the European Heart Journal can be contacted at: W B Saunders Co. Ltd., 32 Jamestown Rd., London NW1 7BY, England.

Keywords: Finland, Oulu, Atrial Fibrillation.

This article was prepared by Science Letter editors from staff and other reports. Copyright 2007, Science Letter via NewsRx.com.