Wolpert Christian, Borggrefe Martin
I. Medizinische Klinik Universitätsklinikum Mannheim Theodor-Kutzer-Ufer 68167 Mannheim E-Mail: christian.wolpert@ med.ma.uni-heidelberg.de, DE.
Herzschrittmacherther Elektrophysiol. 2002 Sep;13(3):149-56. doi: 10.1007/s00399-002-0351-8.
Patients with right bundle branch block and J-point elevations are at risk of sudden death. In the setting of recurrent syncope, polymorphic ventricular tachycardias or aborted sudden death they are highly suspicious of Brugada syndrome. Pharmacological challenge with sodium channel blocking agents in order to unmask or accentuate changes in the right precordial leads towards a prominent J-point elevation is an important diagnostic maneuver. Systematic studies in patients with Brugada syndrome have demonstrated that a significant proportion of patients suffering from this SCN5A-gene mutation react with Brugada-like ECG changes on the administration of sodium channel blocking agents. It is yet unknown to what extent a negative result of pharmacological challenge makes the diagnosis unlikely or excludes the presence of a Brugada syndrome. The pharmacological challenge should be part of the diagnostic work-up in patients who suffer from recurrent cardiogenic syncope, polymorphic tachycardias or aborted sudden death in the absence of structural heart disease and in asymptomatic patients with right bundle branch block and J-point elevations.
患有右束支传导阻滞和J点抬高的患者有猝死风险。在反复晕厥、多形性室性心动过速或猝死未遂的情况下，高度怀疑为Brugada综合征。使用钠通道阻滞剂进行药物激发试验，以揭示或加重右胸前导联向显著J点抬高的变化，是一项重要的诊断手段。对Brugada综合征患者的系统研究表明，很大一部分患有这种SCN5A基因突变的患者在服用钠通道阻滞剂后会出现类似Brugada综合征的心电图变化。目前尚不清楚药物激发试验的阴性结果在多大程度上会使诊断不太可能成立或排除Brugada综合征的存在。对于患有反复的心源性晕厥、多形性心动过速或猝死未遂且无结构性心脏病的患者，以及患有右束支传导阻滞和J点抬高的无症状患者，药物激发试验应作为诊断检查的一部分。
