Eighteen-year analysis of anaesthetic management in Brugada syndrome

BACKGROUND Brugada syndrome (BrS) is a genetic disorder that increases the risk of ventricular tachyarrhythmias and sudden cardiac death (SCD). Certain drugs (propofol, local anaesthetics), fever, bradycardia, increased vagal tone and electrolyte imbalances can trigger or worsen BrS arrhythmias. OBJECTIVE To evaluate the incidence of malignant ventricular arrhythmias during the perioperative period in patients with BrS, hypothesising that common anaesthetic drugs may be safe to use during daily clinical practice. DESIGN The BRUGANAES study was an observational, retrospective project including BrS patients who underwent various types of anaesthesia. SETTING BrS patients undergoing any type of anaesthesia intervention from 1 January 2006, to 31 December 2023, from a tertiary hospital in Barcelona. MAIN OUTCOME MEASURES The primary outcome was the occurrence of malignant ventricular arrhythmias and/or SCD during and up to 30 days postanaesthesia. Secondary outcomes included adverse events during hospitalisation, 30-day readmission rates and 30-day mortality rates. RESULTS Among 652 BrS patients registered in the hospital, 111 patients and 189 procedures were analysed. General anaesthesia was administered in 51.3% of cases, sedation in 36% and regional/neuraxial anaesthesia exclusively in 12.7%. Overall, nonrecommended drugs (propofol, ketamine and local anaesthetics) were used in 129 (68.3%) procedures, either bolus and/or continuous infusion. Epidural blocks were performed in 34% of regional anaesthesia cases, mostly in obstetrics, and subarachnoid blocks in 31.8%. The primary outcome occurred in two patients intraoperatively (1% of procedures): one with bradycardia-induced ventricular fibrillation after a nonrecommended drug and one with transient ventricular tachycardia after a drug not listed as potentially harmful. CONCLUSION To date, this is one of the largest cohorts describing the perioperative approach for BrS patients, including a wide range of anaesthesia procedures and drugs. Most of the patients undergoing anaesthesia for an interventional procedure received an anaesthetic drug classified as not recommended.