From the Guidelines
Alcohol consumption should be avoided or minimized in patients with Brugada syndrome as it can potentially trigger dangerous cardiac arrhythmias. According to the 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death 1, excessive alcohol intake is identified as a potential trigger of ventricular fibrillation (VF) and sudden cardiac arrest (SCA) in Brugada syndrome. The mechanism involves alcohol's effect on cardiac ion channels, particularly sodium channels, which are already dysfunctional in Brugada syndrome. This interaction can further impair cardiac electrical conduction, potentially triggering life-threatening arrhythmias.
Some key points to consider:
- The 2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death also recommend avoidance of excessive alcohol intake in patients with Brugada syndrome 1.
- Factors that can increase the risk of arrhythmic events in patients with Brugada syndrome include fever, excessive alcohol intake, and large meals 1.
- The incidence of arrhythmic events in patients with Brugada syndrome can be as high as 13.5% per year in patients with a history of sudden cardiac arrest, 3.2% per year in patients with syncope, and 1% per year in asymptomatic patients 1.
- Patients with Brugada syndrome should be advised to avoid alcohol consumption or drink very moderately, and be aware of the potential risks of alcohol-induced fever, dehydration, or electrolyte disturbances 1.
In summary, avoiding or minimizing alcohol consumption is crucial for patients with Brugada syndrome to reduce the risk of life-threatening arrhythmias. Patients should discuss specific alcohol consumption guidelines with their cardiologist, as individual risk factors may vary 1.
From the Research
Brugada Syndrome and Alcohol
- There is no direct evidence in the provided studies to suggest a link between alcohol consumption and Brugada syndrome.
- The studies focus on the diagnosis, treatment, and risk stratification of Brugada syndrome, with no mention of alcohol as a contributing factor 2, 3, 4, 5, 6.
Treatment and Management of Brugada Syndrome
- Quinidine has been shown to be effective in preventing ventricular arrhythmias in patients with Brugada syndrome 2, 3.
- Implantable cardioverter-defibrillators (ICDs) are recommended for patients with Brugada syndrome who are at high risk of sudden cardiac death 4, 5.
- Subcutaneous ICDs have emerged as a promising alternative to transvenous ICDs, with low rates of complications and effective shock delivery 5.
Risk Stratification and Diagnosis
- The diagnosis of Brugada syndrome is based on the presence of a spontaneous or drug-induced coved-type ST segment elevation 4, 6.
- Risk stratification is challenging, but several repolarization risk markers and indices incorporating both repolarization and conduction have been proposed to predict arrhythmic risk 6.