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lüll Efficacy of quinidine in high-risk patients with Brugada syndrome Belhassen B; Glick A; Viskin SCirculation 2004[Sep]; 110 (13): 1731-7BACKGROUND: Automatic implantable cardioverter-defibrillator therapy is considered the only effective treatment for high-risk patients with Brugada syndrome. Quinidine depresses I(to) current, which may play an important role in the arrhythmogenesis of this disease. METHODS AND RESULTS: The effects of quinidine bisulfate (mean dose, 1483+/-240 mg) on the prevention of inducible and spontaneous ventricular fibrillation (VF) were prospectively evaluated in 25 patients (24 men, 1 woman; age, 19 to 80 years) with Brugada syndrome. There were 15 symptomatic patients (including 7 cardiac arrest survivors and 7 patients with unexplained syncope) and 10 asymptomatic patients. All 25 patients had inducible VF at baseline electrophysiological study. Quinidine prevented VF induction in 22 of the 25 patients (88%). After a follow-up period of 6 months to 22.2 years, all patients are alive. Nineteen patients were treated with quinidine for 6 to 219 months (mean+/-SD, 56+/-67 months). None had an arrhythmic event, although 2 had non-arrhythmia-related syncope. Administration of quinidine was associated with a 36% incidence of side effects that resolved after drug discontinuation. CONCLUSIONS: Quinidine effectively prevents VF induction in patients with Brugada syndrome. Our data suggest that quinidine also suppresses spontaneous arrhythmias and could prove to be a safe alternative to automatic implantable cardioverter-defibrillator therapy for a substantial proportion of patients with Brugada syndrome. Randomized studies comparing these two therapies seem warranted.|Adult[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Anti-Arrhythmia Agents/adverse effects/pharmacology/*therapeutic use[MESH]|Cardiac Pacing, Artificial[MESH]|Cohort Studies[MESH]|Death, Sudden, Cardiac/prevention & control[MESH]|Defibrillators, Implantable[MESH]|Drug Evaluation[MESH]|Electric Countershock[MESH]|Electrocardiography[MESH]|Female[MESH]|Flecainide[MESH]|Follow-Up Studies[MESH]|Humans[MESH]|Male[MESH]|Middle Aged[MESH]|Potassium Channel Blockers/pharmacology/*therapeutic use[MESH]|Potassium Channels, Voltage-Gated/*drug effects/physiology[MESH]|Prospective Studies[MESH]|Quinidine/adverse effects/pharmacology/*therapeutic use[MESH]|Retrospective Studies[MESH]|Risk[MESH]|Shal Potassium Channels[MESH]|Syndrome[MESH]|Ventricular Fibrillation/diagnosis/etiology/genetics/*prevention & control/therapy[MESH] |