Europace Advance Access published online on December 18, 2007
Europace, doi:10.1093/europace/eum272
Significance of cardiac autonomic neuropathy in risk stratification of Brugada syndrome
Cardiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
Aims: Risk stratification in Brugada syndrome (BS) is controversial especially in asymptomatic individuals. The aim of this study was to evaluate the significance of cardiac autonomic neuropathy (CAN) in BS.
Methods and results: Patients diagnosed with Brugada ECG pattern were enrolled in the study. Four standard cardiac autonomic function tests were performed. The presence of 
2 abnormal test results were considered definite evidence for the presence of CAN. Types 1, 2, and 3 Brugada ECG pattern were found in 28, 56, and 31 patients, respectively. CAN was detected in 13 (46%) patients with type 1 Brugada ECG pattern. In contrast, none of the type 2 or 3 Brugada patients had CAN. Of 13 patients with CAN, 11 had previous history of cardiac events (84%), whereas only 2 of 15 patients without CAN had history of previous cardiac events (13%; P = 0.01). The most noteworthy finding was that all of the type 1 Brugada patients with CAN were male (CAN was not detected in females).
Conclusions: It was concluded that CAN is an important risk indicator in BS. CAN is more common in men. Male gender, per se, is not an independent risk factor for development of ventricular arrhythmia but also CAN, which is an important risk factor in BS, is more common in men; therefore men are susceptible to the development of cardiac events.
Key Words: Arrhythmia, Brugada syndrome, Cardiac autonomic neuropathy
* Corresponding author: Cardiology Department, Namazee Hospital, PO Box 71935-1334, Shiraz, Iran. Tel: +98 711 2277181; fax: +98 711 2277182. E-mail address: draslani{at}yahoo.com
Manuscript submitted 18 June 2007. Accepted after revision 21 November 2007.