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The acquired Brugada syndrome and the paradox of choice

      Consider the following two patients. The first is female, asymptomatic, and develops marked QT prolongation while receiving intravenous procainamide for atrial fibrillation. The second is male, also asymptomatic, and develops coved-type ST-segment elevation in the right precordial leads while receiving intravenous flecainide during a diagnostic test. Most physicians would simply recommend discontinuation of procainamide and avoidance of QT-prolonging medications in the future as the only therapeutic measures needed for the first patient. In contrast, the same physicians would likely perform electrophysiologic studies and, if positive, move on to implant a defibrillator to the second patient.
      • Antzelevitch C.
      • Brugada P.
      • Borggrefe M.
      • et al.
      Brugada syndrome: report of the second consensus conference.
      How did we end up choosing such disparate recommendations for patients with drug-induced long QT syndrome (LQTS) and Brugada syndrome?
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