Brugada syndrome: 12 years of progression.

Brugada syndrome is increasingly being recognized in clinical medicine. What started as an electrocardiographic curiosity has become an important focus of attention for individuals working in the different disciplines related to sudden cardiac death, from basic scientists to clinical cardiac electrophysiologists. In just 12 years, since the description of the disease, clinically relevant information is continuously being provided to physicians to help protect the individuals with Brugada syndrome to the best of our ability. And this information has been gathered thanks to the effort of hundreds of basic scientists, physicians and patients who continue to give their time, effort and data to help understand how the electrocardiographic pattern may cause sudden cardiac death. There are still many unanswered questions, both at the clinical and basic field. However, with the further collection of data, the longer follow-up and the continued interest from the basic science world we will have the necessary tools to the successful unraveling of the disease.</p

Use of intravenous antiarrhythmics to identify concealed Brugada syndrome

Cardiology has recently witnessed the production of an overwhelming amount of data through the advances made in genetics and molecular biology research. Understanding of genetics has tremendous potential to aid in the prevention, diagnosis and treatment of the majority of diseases. Despite the high level of publicity for research discoveries, clinicians have had difficulty in discriminating between what is still basic research and what can be applied to patients. The fact is that we still lack the technology to perform genetic testing in a time frame that is acceptable to clinicians. Meanwhile, then, the only option is to rely on clinical tests that can help us better stratify the individuals at risk for a disease. For example, Brugada syndrome has benefited tremendously from genetics and molecular biology since its initial description in 1992. Genetics will provide a more definitive diagnosis for the disease in the future. For the time being, though, research has shown that the administration of an intravenous class I antiarrhythmic is very useful in identifying patients with a concealed form of the disease

La Cardiologia del segle XXI

Les malalties cardiovasculars, juntament amb el càncer, són dos dels àmbits en què s'han concentrat més els recursos sanitaris els darrers anys. Pel que fa a la cardiologia, hi ha hagut grans avenços en àrees com l'intervencionisme, l'electrofisiologia, el diagnòstic i la cirurgia, i això ha creat tot un seguit d'eines terapèutiques que han fet evolucionar molt el tractament de les malalties cardiovasculars. Pel que fa al futur, la cardiologia s'espera que evolucioni envers una medicina més personalitzada, preventiva, predictiva i participativa, en què el pacient serà un actor ple en la diagnosi de la seva malaltia. Tot això ens portarà a l'anomenada medicina de sistemes.Cardiovascular diseases, along with cancer are two of the areas where health resources are more involved in recent years. As for cardiology, there have been major advances in areas such as intervention, electrophysiology, diagnosis and surgery, and this has created a series of therapeutic tools that have make evolve the treatment of cardiovascular diseases. Regarding the future of cardiology, is expected to evolve towards a more personalized, preventive, predictive and participatory medicine, where the patient is a full actor in the diagnosis of the disease. All this leads to the so-called systems medicine

Negative Autopsy in Infant and Juvenile Population: Role of Cardiac Arrhythmias

Negative autopsy is a post-mortem examination in which a comprehensive analysis does not provide a cause of death. These include situation of death, anatomical and histological analysis, toxicology and microbiological study. A low part of autopsies remain without a conclusive cause of death, but all these cases are usually seen in young population, apparently healthy who died suddenly and unexpectedly. In these situations a cardiac arrhythmia is suspected as cause of death and genetic testing is recommended despite not regularly performed. Sudden death is a natural and unexpected decease that occurs in apparently healthy people, or whose disease was not severe enough to expect a fatal outcome. It can be due to several pathologies, usually of cardiac cause and called sudden cardiac death. In infants and young people, both long QT syndrome and catecholaminergic polymorphic ventricular tachycardia are main causes in negative autopsies. These genetic diseases lead to ventricular fibrillation, syncope and sudden cardiac death in a normal heart. Unfortunately, sudden cardiac death could be the first manifestation of the diseases, being early identification and prevention a crucial point in current medical practice. This chapter focuses on sudden death and negative autopsy in young population, mainly due to cardiac arrhythmias