Drugs and Brugada syndrome patients: Review of the literature, recommendations, and an up-to-date website (www.brugadadrugs.org)

Abstract

Background: Worldwide, the Brugada syndrome has been recognized as an important cause of sudden cardiac death at a relatively young age. Importantly, many drugs have been reported to induce the characteristic Brugada syndrome-linked ECG abnormalities and/or (fatal) ventricular tachyarrhythmias. Objective: To review the literature on the use of drugs in Brugada syndrome patients, to make recommendations based on the literature and expert opinion regarding drug safety, and to ensure worldwide online and up-to-date availability of this information to all physicians who treat Brugada syndrome patients. Methods: We have performed an extensive review of the literature, formed an international expert panel to produce a consensus recommendation to each drug, and initiated a website (www.brugadadrugs.org). Results: The literature search yielded 506 reports to be considered. Drugs were categorized to one of four categories: 1) drugs to be avoided (n=18), 2) drugs preferably avoided (n=23), 3) antiarrhythmic drugs (n=4) and 4) diagnostic drugs (n=4). Level of evidence for most associations was C (only consensus opinion of experts, case studies, or standard-of-care) as there are no randomized studies and few non-randomized studies in Brugada syndrome patients. Conclusions: Many drugs have been associated with adverse events in Brugada syndrome patients. We have initiated a website (www.brugadadrugs.org) to ensure worldwide availability on safe drug use in Brugada syndrome patients.