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.