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

Abstract

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 microg/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.