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European Heart Journal Advance Access originally published online on June 7, 2006
European Heart Journal 2006 27(13):1579-1583; doi:10.1093/eurheartj/ehl060
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Low-dose isoproterenol for repetitive ventricular arrhythmia in patients with Brugada syndrome

Atsuyuki Watanabe*, Kengo Fukushima Kusano, Hiroshi Morita, Daiji Miura, Wakako Sumida, Shigeki Hiramatsu, Kimikazu Banba, Nobuhiro Nishii, Satoshi Nagase, Kazufumi Nakamura, Satoru Sakuragi and Tohru Ohe

Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Okayama 700-8558, Japan

Received 16 January 2006; revised 26 April 2006; accepted 12 May 2006; online publish-ahead-of-print 7 June 2006.

* Corresponding author. Tel: +81 86 235 7346; fax: +81 86 235 7353. E-mail address: wata2034{at}mx31.tiki.ne.jp

Aims Arrhythmic storm or repetitive ventricular arrhythmia (VA) has been occasionally observed in Brugada syndrome (BS). A beta-adrenergic stimulator [isoproterenol (ISP)] has been reported to suppress this arrhythmic storm in sporadic cases. Accordingly, we investigated the antiarrhythmic effects of ISP infusion in consecutive BS patients with arrhythmic storm or repetitive VA.

Methods and results Seven BS patients with arrhythmic storm were studied. Intravenous ISP was administered as a bolus injection (1–2 µg), followed by continuous infusion (0.15 µg/min). Arrhythmic storm or repetitive VA was suppressed immediately after the bolus administration of ISP, which was followed by continuous infusion of low-dose ISP for 1–3 days. In all patients, ST-elevation decreased in right precordial leads. In six of the seven patients, VA subsided after the discontinuance of ISP. RR interval was shortened and ST-elevation in right precordial leads was decreased after ISP bolus injection. ST-elevation in right precordial leads remained decreased during continuous ISP infusion, whereas the RR interval returned to the control level.

Conclusion Continuous administration of low-dose ISP may be effective for the suppression of repetitive VA occurrence in patients with BS.

Key Words: Isoproterenol • Brugada syndrome • Ventricular arrhythmia


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