1. Introduction
Brugada syndrome (BrS) was first described as a clinical syndrome in 1992 and predisposes patients to ventricular fibrillation (VF), premature sudden arrhythmic death syndrome, and aborted sudden cardiac death (SCD). Typically, patients present in the third or fourth decade of life. Even though most patients are asymptomatic at the time of diagnosis (approximately 63%), major arrhythmic events (MAE) can develop at a rate of 12% over 10 years (1-3). The disease is most prevalent in Southeast Asia where the prevalence has been reported as 3.7 per 1,000 and up to 17.7 per 1,000 in Thailand (4, 5).
Drug challenge testing is a common provocation test performed to unmask Type-1 Brugada pattern in patients with suspected BrS. In the past, a drug challenge induced Type-1 Brugada pattern was considered diagnostic of BrS (6). However, the “Shanghai Score System” was recently proposed, and in that, a drug challenge induced Type-1 Brugada pattern is less emphasized and scores as one component of the diagnostic criteria for BrS (1). That said, previous studies have suggested that positive drug challenge testing is associated with MAE (6). There are conflicting data on the incidence of MAE after drug challenge testing and the utilization of drug challenge testing. We sought to systematically review the incidence and the utility of drug challenge testing in the management of patients with possible BrS.