Kontroversi peran studi elektrofisiologi pada sindrom brugada
Abstract
Sindrom Brugada adalah suatu abnormalitas sistem listrik jantung yang merupakan predisposisi terjadinya takikardia ventrikel dan hilang kesadaran. Takikardia ventrikel dapat berhenti spontan dan pasien pulih dari sinkop lalu berobat dengan keluhan sinkop, atau takikardia berdegenerasi menjadi fibrilasi ventrikel (FV)dan menyebabkan kematian jantung mendadak. Oleh karena itu sangat penting mengenal gambaran EKG sindrom Brugada lalu melakukan stratifikasi risiko yang cermat.Salah satu yang menjadi perdebatan hangat adalah stratifikasi risiko sindrom Brugada melalui tindakan studi elektrofisiologi (SEF). Nilai prediktif induksi aritmia ventrikel saat SEF masih kontroversial. Studi yang melibatkan 408 pasien sindrom Brugada tanpa riwayat henti jantung menunjukkan bahwa pasien dengan indusibilitas FV memiliki risiko kematian jantung mendadak karena FV enam kali lipat dalam pengamatan 2 tahun.1 Akan tetapi studi multisenter dari Eropa,2, 3 Jepang4, 5 dan beberapa metaanalisis6, 7 tidak menunjukkan hasil yang positif sehingga indikasi SEF untuk stratifikasi risiko sindrom Brugada hanya IIb pada tahun 2013 (Gambar 1). Metaanalisis8 yang lain memperlihatkan hasil yang positif yaitu ketika presentasi klinis pasien sindrome Brugada dipisahkan antara sinkop dan asimtomatik dalam analisanya.
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References
1. Brugada J, Brugada R, Brugada P. Determinants of sudden cardiac death in individuals with the electrocardiographic pattern of Brugada syndrome and no previous cardiac arrest. Circulation 2003;108(25):3092-6.
2. Priori SG, Gasparini M, Napolitano C, Della Bella P, Ottonelli AG, Sassone B, et al. Risk stratification in Brugada syndrome: results of the PRELUDE (PRogrammed ELectrical stimUlation preDictive valuE) registry. J Am Coll Cardiol 2012;59(1):37-45.
3. Probst V, Veltmann C, Eckardt L, Meregalli PG, Gaita F, Tan HL, et al. Long-term prognosis of patients diagnosed with Brugada syndrome: Results from the FINGER Brugada Syndrome Registry. Circulation 2010;121(5):635-43.
4. Takagi M, Yokoyama Y, Aonuma K, Aihara N, Hiraoka M. Clinical characteristics and risk stratification in symptomatic and asymptomatic patients with brugada syndrome: multicenter study in Japan. J Cardiovasc Electrophysiol 2007;18(12):1244-51.
5. Kamakura S, Ohe T, Nakazawa K, Aizawa Y, Shimizu A, Horie M, et al. Long-term prognosis of probands with Brugada-pattern ST-elevation in leads V1-V3. Circ Arrhythm Electrophysiol 2009;2(5):495-503.
6. Gehi AK, Duong TD, Metz LD, Gomes JA, Mehta D. Risk stratification of individuals with the Brugada electrocardiogram: a meta-analysis. J Cardiovasc Electrophysiol 2006;17(6):577-83.
7. Paul M, Gerss J, Schulze-Bahr E, Wichter T, Vahlhaus C, Wilde AA, et al. Role of programmed ventricular stimulation in patients with Brugada syndrome: a meta-analysis of worldwide published data. Eur Heart J 2007;28(17):2126-33.
8. Fauchier L, Isorni MA, Clementy N, Pierre B, Simeon E, Babuty D. Prognostic value of programmed ventricular stimulation in Brugada syndrome according to clinical presentation: an updated meta-analysis of worldwide published data. Int J Cardiol 2013;168(3):3027-9.
9. Sieira J, Conte G, Ciconte G, de Asmundis C, Chierchia GB, Baltogiannis G, et al. Prognostic value of programmed electrical stimulation in Brugada syndrome: 20 years experience. Circ Arrhythm Electrophysiol 2015;8(4):777-84.
10. Belhassen B, Michowitz Y. Arrhythmic risk stratification by programmed ventricular stimulation in Brugada syndrome: the end of the debate? Circ Arrhythm Electrophysiol 2015;8(4):757-9.
2. Priori SG, Gasparini M, Napolitano C, Della Bella P, Ottonelli AG, Sassone B, et al. Risk stratification in Brugada syndrome: results of the PRELUDE (PRogrammed ELectrical stimUlation preDictive valuE) registry. J Am Coll Cardiol 2012;59(1):37-45.
3. Probst V, Veltmann C, Eckardt L, Meregalli PG, Gaita F, Tan HL, et al. Long-term prognosis of patients diagnosed with Brugada syndrome: Results from the FINGER Brugada Syndrome Registry. Circulation 2010;121(5):635-43.
4. Takagi M, Yokoyama Y, Aonuma K, Aihara N, Hiraoka M. Clinical characteristics and risk stratification in symptomatic and asymptomatic patients with brugada syndrome: multicenter study in Japan. J Cardiovasc Electrophysiol 2007;18(12):1244-51.
5. Kamakura S, Ohe T, Nakazawa K, Aizawa Y, Shimizu A, Horie M, et al. Long-term prognosis of probands with Brugada-pattern ST-elevation in leads V1-V3. Circ Arrhythm Electrophysiol 2009;2(5):495-503.
6. Gehi AK, Duong TD, Metz LD, Gomes JA, Mehta D. Risk stratification of individuals with the Brugada electrocardiogram: a meta-analysis. J Cardiovasc Electrophysiol 2006;17(6):577-83.
7. Paul M, Gerss J, Schulze-Bahr E, Wichter T, Vahlhaus C, Wilde AA, et al. Role of programmed ventricular stimulation in patients with Brugada syndrome: a meta-analysis of worldwide published data. Eur Heart J 2007;28(17):2126-33.
8. Fauchier L, Isorni MA, Clementy N, Pierre B, Simeon E, Babuty D. Prognostic value of programmed ventricular stimulation in Brugada syndrome according to clinical presentation: an updated meta-analysis of worldwide published data. Int J Cardiol 2013;168(3):3027-9.
9. Sieira J, Conte G, Ciconte G, de Asmundis C, Chierchia GB, Baltogiannis G, et al. Prognostic value of programmed electrical stimulation in Brugada syndrome: 20 years experience. Circ Arrhythm Electrophysiol 2015;8(4):777-84.
10. Belhassen B, Michowitz Y. Arrhythmic risk stratification by programmed ventricular stimulation in Brugada syndrome: the end of the debate? Circ Arrhythm Electrophysiol 2015;8(4):757-9.
Published
2016-05-02
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How to Cite
Yuniadi, Y. (2016). Kontroversi peran studi elektrofisiologi pada sindrom brugada. Indonesian Journal of Cardiology, 36(4), 183-5. https://doi.org/10.30701/ijc.v36i4.500
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