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Europace Advance Access published online on January 8, 2009
Europace, doi:10.1093/europace/eun365
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

SHORT COMMUNICATION

Effect of baroreflex stimulation using phenylephrine injection on ST segment elevation and ventricular arrhythmia-inducibility in Brugada syndrome patients

Vincent Probst1,2,3,*, Philipe Mabo4, Frederic Sacher5, Dominique Babuty6, Jacques Mansourati7 and Hervé Le Marec1,2,3

1 INSERM, UMR915, Nantes F-44000, France; 2 Université de Nantes, l’institut du Thorax, Nantes F-44000, France; 3 CHU Nantes, l’institut du Thorax, Service de Cardiologie, Nantes F-44000, France; 4 Departement de Cardiologie, Hôpital Pontchaillou, Rennes, France; 5 Service de Cardiologie, Hôpital Cardiologique du Haut Leveque, Bordeaux, France; 6 Service de Cardiologie B, Hôpital Trousseau, Tours, France; 7 Service de Cardiologie, Centre Hospitalo-Universitaire de Brest, Brest, France

Aims: Patients affected by Brugada syndrome (BrS) are at risk of sudden cardiac death specifically at rest, when vagal tone is high. The aim of our study was to assess whether a phenylephrine injection, which provokes a baroreflex stimulation, could induce modification of the ST segment elevation and ventricular arrhythmias.

Methods and results: Baroreflex test was performed with the administration of phenylephrine (2 µg/kg) to four highly symptomatic patients in a setting fully equipped for cardiac resuscitation. Phenylephrine injection induced a deep vagal stimulation with a decrease in the mean heart rate from 75 ± 7 to 50 ± 8 bpm and an increase in the mean systolic blood pressure from 141 ± 14 to 204 ± 46 mmHg. ST segment elevation was not modified and no ventricular arrhythmias were induced during the test.

Conclusion: Although phenylephrine injection induced a major {alpha}-adrenergic vasoconstriction followed by an arterial baroreflex, this test failed to provoke ventricular arrhythmias or modification of the ST segment elevation in BrS patients.

Key Words: Brugada syndrome, Arrhythmic risk, Risk stratification, Baroreflex, Phenylephrine, Vagal stimulation

* Corresponding author: Service de cardiologie du CHU de Nantes, CHU de Nantes, Hôpital Nord, Bd Jacques Monod, 44093 Nantes Cedex, France. Tel: +33 2 16 50 08, Fax: +33 240165024, Email: vincent.probst{at}chu-nantes.fr

Manuscript submitted 6 September 2008. Accepted after revision 1 December 2008.


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