Newly Published
Editorial  |   January 2020
Challenge of Anesthesia Management in Brugada Syndrome
Author Notes
  • From the Department of Cardiovascular Anesthesia and Intensive Care, Scientific Clinical Research Hospital (IRCCS) Policlinico San Donato, San Donato Milanese, Milan, Italy.
  • This editorial accompanies the article on p. XXX.
    This editorial accompanies the article on p. XXX.×
  • Accepted for publication October 29, 2019.
    Accepted for publication October 29, 2019.×
  • Correspondence: Address correspondence to Dr. Ranucci: cardioanestesia@virgilio.it
Article Information
Editorial / Cardiovascular Anesthesia
Editorial   |   January 2020
Challenge of Anesthesia Management in Brugada Syndrome
Anesthesiology Newly Published on January 8, 2020. doi:https://doi.org/10.1097/ALN.0000000000003099
Anesthesiology Newly Published on January 8, 2020. doi:https://doi.org/10.1097/ALN.0000000000003099
In this issue of Anesthesiology, Flamée et al. present a randomized controlled trial on the electrocardiographic effects of propofol versus etomidate for induction of anesthesia in Brugada syndrome patients.1  Due to its randomized controlled nature, this study is unique within the few scientific contributions to this matter. The authors could not find any evidence of a worsening electrocardiographic pattern in propofol-treated patients, conversely showing a decrease in ST-elevation (a favorable electrocardiographic change) in 30% of these patients.1 
The Brugada syndrome is an inherited disease characterized by coved-type ST-segment elevation in the right precordial leads on the electrocardiogram and increased risk of ventricular fibrillation and sudden cardiac death, in the absence of structural heart disease. There are three different electrocardiographic patterns in Brugada syndrome. The type 1 electrocardiographic pattern is characterized by a pronounced elevation of the J point, a coved-type ST segment, and an inverted T wave in V1 and V2. The type 2 pattern has a saddleback ST-segment elevated by more than 1 mm, and in the type 3 pattern, the ST segment is elevated less than 1 mm. The type 1 electrocardiographic pattern is diagnostic of Brugada syndrome, whereas types 2 and 3 patterns require antiarrhythmic drug challenge to be unmasked and converted into type 1.2