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2000, Número 3

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Arch Cardiol Mex 2000; 70 (3)


Elevación del ST, bloqueo de rama derecha y muerte súbita: Síndrome de Brugada

Asensio LE, Álvarez MB, Lozano DE, Farías VA, Brugada TR, Brugada TP, Brugada TJ

Idioma: Español
Referencias bibliográficas: 49
Paginas: 301-311
Archivo PDF: 461.06 Kb.


RESUMEN

El síndrome de Brugada es una de las principales causas de muerte súbita en adultos jóvenes sin enfermedad cardiaca estructural. Se trata de una enfermedad eléctrica cardiaca caracterizada por una mutación del gen SCN5A en el cromosoma 3, con transmisión autosómica dominante, que da lugar a una disfunción del canal de sodio. Esta se acompaña de un incremento en la Ito que implica pérdida del domo de la fase 2 del potencial de acción epicárdico. Esta alteración se asocia con una repolarización del tipo “Todo o nada” que origina una reentrada en fase dos. Dicha reentrada es la responsable de iniciar y perpetuar a las arritmias ventriculares (taquicardia o fibrilación ventricular) en estos pacientes. El patrón electrocardiográfico de bloqueo de rama derecha, elevación del ST de V1 a V3 y la presencia de muerte súbita o síncope son las características clínicas de este síndrome. En algunos enfermos es necesario realizar una prueba farmacológica con ajmalina o procainamida para evidenciar los cambios eléctricos. El único tratamiento disponible en la actualidad es el desfibrilador automático implantable (DAI). Con este aparato se reduce la mortalidad desde un 40% anual a un 0% a diez años. El tratamiento farmacológico no es útil.


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