Atrial fibrilation in Brugada syndrom

Abstract

Introduction. Atrial fibrilation is the most common cardiac arrhythmia with the worldwide prevalence of more than 33.5 million people and is a subject with increased interest in clinical trials. The reason is the awareness of the high risk of embolic events that in 75 % are complicated by cerebrovascular accidents. It is estimated that the number of patients with AF in 2030 in Europe will be 14–17 million and the number of new cases of AF per year at 120,000–215,000. In approximately 80% of patients, atrial fibrillation is associated with organic heart disease including valvular heart disease (mostly mitral valve disease), coronary artery disease, hypertension, hypertrophic or dilated cardiomyopathy. In 20% of cases, atrial fibrillation occurs in the absence of organic heart disease. Besides the danger of embolic events, atrial fibrillation is the most common atrial arrhythmia found in Brugada syndrome which is associated with malignant ventricular arrhythmias and sudden cardiac death. Aim of the study. The purpose of this study was to review data about characteristics and management of atrial fibrillation in Brugade syndrome. Materials and methods. The source of information was represented by articles published in the online databases: PubMed, HINARI, SCOPUS, EMBASE Results. Current evidence revealed that the prevalence of AF in patients in BrS vastly differs among publish studies, ranged from 6% to 39%. The only genetic mechanism of arrhythmias is related to the mutation of the SCN5A gene that encodes cardiac sodium channels. However, as this sodium channel is found not only in the ventricular tissue, but also in the atria, this could lead to reentrant tachyarrhythmias in the atrium. Nevertheless, management of BrS with AF remains a difficult task, as medication for AF, such as sodium channel blockers, confers their risk owing to their proarrhythmic effects in patients with BrS. In addition, other than quinidine and disopyramide cannot be used because they block sodium channels and cause ventricular arrhythmias. Recent evidence suggested that catheter ablation could be utilized as a first‐line therapy for paroxysmal AF in BrS patients. For the last 2 decades, ICD therapy has been considered as the cornerstone therapy of patients with documented ventricular tachyarrhythmia, but recent studies has been associated ICD therapy with a significant rate of complications, and should be avoided in asymptomatic patients. The most common of these complications are inappropriate shocks, which cause pain, and can produce psychological trauma. Pulmonary vein isolation (PVI) is an effective method for controlling paroxysmal AF. The literature indicates that the success rate of PVI is 79.8% in the long term in patients with brugada syndrome. Conclusions. According to studies, PVI has been shown to have minimal risk of complications and is considered one of the most effective long-term methods in the control of atrial fibrillation and brugade syndrome. This treatment method could be considered the first line of treatment for atrial fibrillation and in brugade syndrome.