Talk:Brugada syndrome

Untitled

There is a problem with the lower EKG image and its legend. The legend refers to two panels, one after treatment. The figure shows three panels for three different classes of the syndrome.

98.64.68.45 (talk) 12:24, 8 October 2009 (UTC)

I agree with the poster below that the subjects should not be merged because their definitions differ. In addition, the disorders described as SUD (or SUNDS, Sudden Unexplained Nocturnal Death Syndrome) such as Bangungot can be classified as ethnomedical disorders. The description of the phenomena and traditional cures will undoubtedly differ in each case. To lump any or all of them together as Brugada seems reductionist and ethnocentric. Doing so would probably not only be scientifically wrong, but gives precedence to a biological cause and Western medical remedy (as found in the Brugada article) rather than allowing for a focus on the psycho-social reality of each disorder and valuable discussions of traditional remedies. I would suggest that there should be a section on linked ethnomedical disorders in the main Brugada article and that there should be links to each of the disorders' articles at the end of the Brugada article.

This link should take you to a 2002 article in Human Molecular Genetics which indicates a genetic link between SUNDS and Brugada: hmg.oxfordjournals.org/cgi/reprint/11/3/337.pdf

On a related note, More information on some of the ethnomedical disorders linked to SUNDS (particularly in Hmong men) can be found below. SUNDS has long been linked to sleep paralysis. See:

1) Hufford, David J. The Terror That Comes in the Night. Philadelphia: University of Pennsylvania Press, 1982. 2) Adler, Shelly R. "The Role of the Nightmare in Hmong Sudden Unexpected Nocturnal Death Syndrome: A Folkloristic Study of Belief and Health." Ph.D. diss., University of California--Los Angeles, 1991, 48-61. 3) Adler, Shelly R. "Sudden Unexpected Nocturnal Death Syndrome among Hmong Immigrants: Examining the Role of the 'Nightmare'," Journal of American Folklore 104 (1991): 54-71 Lorist 21:34, 6 August 2007 (UTC)

..one may call that an amateur page...

... and just what have _you_ written?

Brugada syndrome is a well defined entity, whereas the other ones are more ill-defined. There is no doubt that Brugada syndrome is a part of the others but other diseases is also part of SUDS and sudden death in asia. Therefore the subjects should not be merged.

---

A good reference:

1. Priori SG, Aliot E, Blomstrom-Lundqvist C, Bossaert L, Breithardt G, Brugada P, Camm AJ, Cappato R, Cobbe SM, Di Mario C, Maron BJ, McKenna WJ, Pedersen AK, Ravens U, Schwartz PJ, Trusz-Gluza M, Vardas P, Wellens HJ, Zipes DP. Task Force on Sudden Cardiac Death of the European Society of Cardiology. Eur Heart J. 2001 Aug;22(16):1374-450. (Medline abstract)

Ksheka 11:54, Aug 24, 2004 (UTC)

Hi, I am an ICD patient myself as a result of going into ventricular fibrillation in my sleep in 2004. This is also known as SADS (Sudden arrhythmic death syndrome).

I have been genetically tested for the genes related to Brugada in 2005. The result was negative but I am having more genetic tests done. I have just recently had a blood sample taken for the second time. Hopefully they can research more into this. I have more information regarding brugada syndrome and my doctor has already met Dr. Brugada himself.

I would like to add more information about testing for Brugada. There is a drug called "ajmaline" which I was tested with to see if any abnormalities in my ECG showed up. Perhaps I could add this to the article and other information too?Smsmasters 09:02, 28 June 2007 (UTC)

Ajmaline and other drugs for diagnosis of BS

All Class Ic "sodium current blocking agents" could be used to reveal hidden ECG abnormalities to diagnose this entity. However, prognostic significance of this test is quite questionable, indeed people without any VF episodes or spontaneous ECG changes has very little chance to develop a sudden cardiac death. Also, a new "old" drug is currently popular in treatment of Brugada syndrome: Quinidine. So I added some info about this topic with reference. —Preceding unsigned comment added by Lord Xar (talk • contribs) 22:15, 18 September 2007 (UTC)

Drugs associated with Brugada syndrome

You could add a link to [www.brugadadrugs.org] on the wiki, a site discussing drugs associated with Brugada syndrome and lists of drugs to avoid.

Petertje puk (talk) 19:16, 29 June 2009 (UTC)

External links modified

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Revision of lead

Hi @Doc James:, I have just realised that the edits I made to the Brugada page yesterday inadvertently deleted the infobox, sorry.

I see that you in addition to restoring the infobox, you reverted the changes I made to the lead, with your comment being MEDMOS. I'd be grateful if you could help me understand in what way my version of the lead (pasted below) falls foul of MEDMOS - I felt it was an improvement as it avoided technical terms like 'vagal tone' which may be challenging for a lay reader to understand, while summarising the key points in the main body of the article below. I appreciate that you have a lot of Wiki experience and welcome your feedback. Thanks PeaBrainC (talk) 21:49, 17 January 2018 (UTC)

@Doc James:, PeaBrainC (talk) 20:07, 18 January 2018 (UTC)

Brugada syndrome (BrS) is a genetic condition which results in abnormal electrical activity within the heart, increasing the risk of abnormal heart rhythms and sudden cardiac death. These abnormal heart rhythms often occur at rest or after a heavy meal, and can be triggered by a fever, excessive alcohol, or certain medications. The symptoms of Brugada syndrome include fainting but those affected may not have any symptoms at all.

As an inherited condition, about a quarter of those affected by Brugada syndrome will have a relative who also has the condition. It may be caused by mutations in the SCN5A gene responsible for the cardiac sodium channel, although mutations causing the condition have also been found in other genes.

Brugada syndrome is typically diagnosed using an electrocardiogram (ECG), although medications such as ajmaline may be required to produce the characteristic ECG pattern. There is no cure for Brugada syndrome, but the condition may be treated using an implantable cardioverter defibrillator (ICD). Medications to help control the abnormal heart rhythms include isoproterenol in those who are acutely unstable, and quinidine. The family members of a patient with Brugada syndrome may require testing for the condition.

The ordering of sections is described at WP:MEDMOS.

Why did you remove epidemiology from the lead? Why did you remove this "Some cases may be due to a new mutation or certain medications.", why did you remove the year it was discovered?

Often the lead follows the ordering of the body which it did before.

This text was unreferenced. "It may be caused by mutations in the SCN5Agene responsible for the cardiac sodium channel, although mutations causing the condition have also been found in other genes." Doc James (talk · contribs · email) 23:47, 18 January 2018 (UTC)

Thanks @Doc James:, that clarifies things. I'll try to rewrite my version incorporating your advice as I still believe the lead as it stands can be improved. PeaBrainC (talk) 21:45, 21 January 2018 (UTC)

Also you will note that every sentence in the lead is referenced to a decent source.

The body of the article needs more work than the lead. Doc James (talk · contribs · email) 00:47, 22 January 2018 (UTC)

References in the lead

Were does this ref mention after meals or during sleep?

Not seeing "while quinidine may be used in the longer term" in https://rarediseases.org/rare-diseases/brugada-syndrome/ Found the ref and added it to the sentence in question.

Doc James (talk · contribs · email) 18:49, 9 March 2018 (UTC)

GA Review

This review is transcluded from Talk:Brugada syndrome/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Natureium (talk · contribs) 16:25, 11 July 2018 (UTC)

I've never done a GAN review before, so please let me know (politely) if I'm doing anything wrong.

GA review – see WP:WIAGA for criteria

1. Is it well written?

   A. The prose is clear and concise, and the spelling and grammar are correct:

   Suggested changes:

   Lead: new mutation -> new genetic mutation : Done PeaBrainC (talk) 20:59, 12 July 2018 (UTC)

   Causes: disturbed -> disrupted? : Done PeaBrainC (talk) 20:59, 12 July 2018 (UTC)

   Don't know if " known as loss of function mutations." fits in the paragraph : Done PeaBrainC (talk) 20:59, 12 July 2018 (UTC)

   Does the term "overlap syndrome" apply? The article on overlap syndrome only describes it in the context of autoimmune connective tissue disorders.: Not done Overlap syndrome is certainly a correct term to describe, for example, the phenotype of Brugada and Long QT 3 syndrome in the same patient, or Brugada and ARVC. I appreciate the current article for overlap syndrome doesn't explicitly mention this and I will try to add a paragraph to that article in due course PeaBrainC (talk) 20:59, 12 July 2018 (UTC)

   I have now amended the article on Overlap syndrome to better reflect that this term is used to refer to more than just autoimmune conditions. PeaBrainC (talk) 17:19, 13 July 2018 (UTC)

   in SCN5A that reduced -> reduces : Done PeaBrainC (talk) 20:59, 12 July 2018 (UTC)

Mechanism: heart racing -> rapid heart rate : Done PeaBrainC (talk) 17:19, 13 July 2018 (UTC)

1. Diagnosis: link to ST elevation : Done PeaBrainC (talk) 17:19, 13 July 2018 (UTC)

   Choose either Genetic testing or Causes/genetics to mention incomplete penetrance : Done PeaBrainC (talk) 17:19, 13 July 2018 (UTC)

   "occurring as a bystander" is unnecessary and somewhat confusing : Done PeaBrainC (talk) 17:19, 13 July 2018 (UTC)

   Treatment: per WP:EL, external links do not belong in the body : Done PeaBrainC (talk) 17:19, 13 July 2018 (UTC)

   History: see in -> seen in : Done PeaBrainC (talk) 17:19, 13 July 2018 (UTC)

   lead to competing theories -> led to : Done PeaBrainC (talk) 17:19, 13 July 2018 (UTC)

   B. It complies with the manual of style guidelines for lead sections, layout, words to watch, fiction, and list incorporation:

2. Is it verifiable with no original research?

   A. It contains a list of all references (sources of information), presented in accordance with the layout style guideline:

   B. All in-line citations are from reliable sources, including those for direct quotations, statistics, published opinion, counter-intuitive or controversial statements that are challenged or likely to be challenged, and contentious material relating to living persons—science-based articles should follow the scientific citation guidelines:

   Sources # 9, 16, 17, 18, 19, 21, 22, 25, 28, 39, 41, 42, are primary sources, but are mainly used for background information

   C. It contains no original research:

   D. It contains no copyright violations nor plagiarism:

3. Is it broad in its coverage?

   A. It addresses the main aspects of the topic:

   B. It stays focused on the topic without going into unnecessary detail (see summary style):

4. Is it neutral?

   It represents viewpoints fairly and without editorial bias, giving due weight to each:

5. Is it stable?

   It does not change significantly from day to day because of an ongoing edit war or content dispute:

6. Is it illustrated, if possible, by images?

   A. Images are tagged with their copyright status, and valid fair use rationales are provided for non-free content:

   B. Images are relevant to the topic, and have suitable captions:

7. Overall:

   Pass or Fail:

Hi @Natureium:, thanks for reviewing this article. It's only my 2nd GAN but to my inexperienced eyes looks like you've done a good job. I will get on with making the amendments you have suggested and mark them as done on this page as I go. It may take a few days - busy times in the real world! PeaBrainC (talk) 09:48, 12 July 2018 (UTC)

Looks good! Congrats! Natureium (talk) 21:50, 12 July 2018 (UTC)

abnormal heart rhythm

Sentence 4 begins: The abnormal heart rhythm often occurs. The The implies that the reader is to know which abnormal hear rhythm we are talkin about. But no abnormal heart rhythm has been mentioned, I think. That is, I think that there are heart disorders that are not abnomal heart rhythms. Even if there aren't, we should not assume that all readers know this.--Ettrig (talk) 20:57, 12 July 2018 (UTC)  Done PeaBrainC (talk) 17:06, 13 July 2018 (UTC)

This is referring to the abnormal heart rythmns that these people get. Doc James (talk · contribs · email) 13:34, 13 July 2018 (UTC)

Technical language, accuracy and precision of statements

Hi Yanping, I wonder if we could have a discussion on the talkpage about our differences of opinion regarding the best form of language to use in the article. I don't want to edit war and am loathe to change your edits again without consensus, so I'm bringing it to the table here.

In your recent edit summaries you have suggested that "this page should be written for academics and professionals, if laypeople don’t know what sodium channels are they’re supposed to follow wikilinks" and that "this is a science article, not a brochure for patients". All the manuals of style suggest that articles should be written in a style suitable for a non specialist. From WP:BATTLE - "Texts should be written for everyday readers, not just for academics", and "While wikilinks should be provided for advanced terms and concepts in that field, articles should be written on the assumption that the reader will not or cannot follow these links, instead attempting to infer their meaning from the text."

In addition to our differences of opinion on writing style there are questions to be raised regarding the accuracy of what you have changed. Whether the prose is more or less technically oriented, it needs to be correct. For example, SCN5A is a gene. NaV1.5 is the protein forming the alpha subunit of the cardiac sodium channel that SCN5A encodes. INa is the current that NaV1.5 carries. These terms should not be mixed up as was done in your recent set of edits. Furthermore, Brugada has nothing to do with the late sodium current - increased late INa is responsible for the LQT3 form of long QT syndrome. Brugada is an oligogenic disorder but the association with sodium is entirely to do with a reduction in the peak current. It is wrong to say that BrS is due to mutations in SCN5A - a proportion of cases of BrS are associated with SCN5A mutations but in the majority no causative gene can be found.

Comparing your most recent version of the first paragraph of the causes section:

"The individual cells of the heart communicate with each other with electrical signals, and these electrical signals are disrupted in those with Brugada syndrome due to mutations in SCN5A, a cardiac sodium channel which is responsible for depolarizing the cardiomyocyte during phase 0 of the cardiac action potential by permitting the early component of the sodium current as well as permitting a residual current lasting throughout the low-conductance phases of repolarization, known as the late sodium current. Many of the genetic mutations that have subsequently been described in association with Brugada syndrome influence the early and late components of the sodium current in some way, often differentially, or affect other ionic currents."

to the previous version:

"The individual cells of the heart communicate with each other with electrical signals, and these electrical signals are disrupted in those with Brugada syndrome. As a genetic condition, the syndrome is ultimately caused by changes to a person's DNA, known as genetic mutations. The first mutations described in association with Brugada syndrome were in a gene responsible for a protein or ion channel that controls the flow of sodium ions through the cell membrane of heart muscle cells – the cardiac sodium channel. Many of the genetic mutations that have subsequently been described in association with Brugada syndrome influence the sodium current in some way, or affect other ionic currents."

I feel that the earlier version was more accurate and worded in a way more appropriate to a non-specialist audience. Like I say, I'm not going to revert again, but would appreciate the opinions of others who have previously shown an interest in the article. @Yanping Nora Soong: @Doc James: @TylerDurden8823:. Thanks, PeaBrainC (talk) 17:00, 14 February 2019 (UTC)

Thanks User:PeaBrainC Yes we are to write in easier to understand language.

Also this "This disruption is due to mutations in SCN5A, a cardiac sodium channel which is responsible for depolarizing the heart muscle cells during phase 0 of the cardiac action potential by permitting the early component of the sodium current as well as permitting a residual current lasting throughout the low-conductance phases of repolarization, known as the late sodium current." is an indepth description of the mechanism rather than a cause per say. Doc James (talk · contribs · email) 17:15, 14 February 2019 (UTC)

Hi Yanping, if I've understood your intentions correctly, you would like there to be some mention of the relationship between SCN5A mutations, the sodium current, and the subsequent effects on the action potential. I agree that this would be useful information to add to the article, probably in the Mechanisms section. How about splitting the paragraph concerning conduction, and adding something like this to it:

"The genetic variants associated with BrS support the concept that slowed conduction could be responsible for generating these arrhythmias. SCN5A, the gene most commonly associated with BrS, along with SCN10A, SCN1B, SCN2B and SCN3B, all directly affect the sodium current I_Na. This current is a major contributor to the characteristic flow of electrical charge across the membrane of heart muscle cells that occurs with each heartbeat known as the action potential. The sodium current causes the initial rapid upstroke of the action potential (phase 0), and decreasing this current, as occurs in BrS-associated genetic variants, leads to slowing of the electrical conduction through the heart muscle." (with references to one of the reviews already cited).

It's tricky to convey this information in a non-technical way but would this work? @Yanping Nora Soong: PeaBrainC (talk) 09:50, 15 February 2019 (UTC)

Yes. And then we could also address the late current and the interaction of LQTS3 and BrS in a separate paragraph. (This is the context in which I was first acquainted with Brugada.) Yanping Nora Soong (talk) 17:17, 15 February 2019 (UTC)

Placing the content in the mechanism section and using easier to understand language addresses my concerns. Doc James (talk · contribs · email) 17:35, 15 February 2019 (UTC)

The pathophysiology is interlinked with the genetic causes. Sometimes certain exceptions apply to the MOS. The section headers should be organized after the content that adequately informs the reader of BrS, rather than organizing the section headers first, and then the content to the headers. That would be the tail wagging the dog. For example, in Long_QT_syndrome#Genetics the discussion of genetic risk factors adequately sets up the article for pathophysiological discussion in the next section. Yanping Nora Soong (talk) 17:57, 15 February 2019 (UTC)

For ease of understanding IMO the causes and pathophysiology should be kept mostly separate.

Causes can generally be provided in easier to understand language than pathophysiology and thus are better going first. Doc James (talk · contribs · email) 16:25, 17 February 2019 (UTC)

History text

"As early as December 1981, the Center for Disease Control described sudden cardiac death during sleep of predominantly male Southeast Asian refugees. According to the CDC report, "The abruptness of the deaths reported here is compatible with a cardiac dysrhythmia ... but the underlying mechanism remains unclear." This syndrome was called sudden arrhythmic death syndrome or sudden unexpected nocturnal death syndrome (SUNDS). Brugada syndrome was described as a cause for SUNDS seen in Thai men in 1997. Brugada syndrome has been determined to be "phenotypically, genetically and functionally identical" to SUNDS in Thailand, where it is known as Lai Tai and Japan where it is known as Pokkuri and it has been proposed that there is similar equivalence between Brugada syndrome and Filipino subset of SUNDS, locally known as Bangungut ("nightmare"). These cultures had been familiar with Brugada-linked SUNDS well before Occidental physicians had become acquainted with the pattern, with a Philippine medical journal noting "Such ‘deadly dreams’ are well known among the lay people, many of whom view them with sullen respect, if not frank terror." "

This is all the Wikipedians interpretation of primary sources. Please use high quality secondary sources. Doc James (talk · contribs · email) 22:32, 14 February 2019 (UTC)

References

The secondary source linking them is here. This is not my interpretation. We also have a separate article for SUNDS. Yanping Nora Soong (talk) 22:36, 14 February 2019 (UTC)

That [1] is not a suitable secondary source. Doc James (talk · contribs · email) 22:38, 14 February 2019 (UTC)

Certainly it's not OR. The intention here is to counter systemic bias, especially where western physicians are eager to claim credit for the groundwork of medical providers in Asia. I have access to plenty of sources, if you would stop reverting my edits and also changing redirects to already-established articles. Yanping Nora Soong (talk) 22:43, 14 February 2019 (UTC)

Here are three secondary sources that cover the history of the condition

• https://www.ncbi.nlm.nih.gov/pubmed/26764071
• https://www.ncbi.nlm.nih.gov/pubmed/26627541
• https://www.ncbi.nlm.nih.gov/pubmed/11969284

Please use these. Doc James (talk · contribs · email) 22:55, 14 February 2019 (UTC)

What's wrong with this AHA 2018 review? Yanping Nora Soong (talk) 23:11, 14 February 2019 (UTC)

That one would be fine aswell. You however need to self revert your last edits and wait for consensus. Doc James (talk · contribs · email) 23:32, 14 February 2019 (UTC)

I won't revert you if you revert back, I have to leave class now. I haven't been given a preferred revision to revert to. Yanping Nora Soong (talk) 23:33, 14 February 2019 (UTC)

Removing of secondary source

"Sudden unexplained nocturnal death syndrome, bangungut, pokkuri death syndrome"

Why was this removed? Doc James (talk · contribs · email) 22:33, 14 February 2019 (UTC)

This source already exists. Furthermore, Brugada is NOT the same as sudden unexplained nocturnal death syndrome, which we have separate article for. Are you proposing an article merger? Yanping Nora Soong (talk) 22:34, 14 February 2019 (UTC)

One already redirects to the other... We DO NOT have a separate article.

We do have high quality secondary sources that that name is also used for this condition.[2] Doc James (talk · contribs · email) 22:36, 14 February 2019 (UTC)

Doc James, you changed the redirect yourself. That's disingenuous. See sudden arrhythmic death syndrome, which is the true synyonym for SUNDS. Yanping Nora Soong (talk) 22:41, 14 February 2019 (UTC)

Ah yes in October 28 of 2017.[3]

The same name can be used for multiple conditions. This occurs relatively commonly.

And serious one is a subtype of the other Doc James (talk · contribs · email) 22:47, 14 February 2019 (UTC)

Brugada syndrome is not the same as SUNDS

See this 2018 review in JAHA: In the following decades, investigators have been engaged in revealing the relationship between SUNDS and BrS, but there still has not been a definitive conclusion.25, 32 Nevertheless, it is commonly recognized that VA is a major cause of SUNDS.32, 33 The following risk factors presumed to be involved in SUNDS may also trigger VA. Yanping Nora Soong (talk) 23:28, 14 February 2019 (UTC)

The same name can be used for multiple conditions. Ref also says "SUNDS then appears to be the same disorder as BrS in epidemiology and phenotype. The initial molecular genetic study proposed that SUNDS was the same as BrS in genotype and function defects. However, patients enrolled in this study were more likely to be diagnosed as BrS. Thus, whether SUNDS is allelic to BrS in genetics and functional defects requires further evaluation." Doc James (talk · contribs · email) 00:08, 15 February 2019 (UTC)

If you think the NIH is incorrect feel free to reach out to them.[4]

They are not claiming that the conditions are exactly the same just that the term SUNDS is sometimes used for Brugada. Not an extra ordinary claim. Doc James (talk · contribs · email) 00:18, 15 February 2019 (UTC)

Could we address this issue in-article? The link between SUNDS and Brugada, as well as the contextual history tying them together, shouldn't just be relegated to synonyms, dabs and redirects. Yanping Nora Soong (talk) 17:14, 15 February 2019 (UTC)

What reference would you like to use? And what text would you like to add based on that text?

We already have "In these countries Brugada syndrome is likely to be responsible for many cases of sudden unexpected nocturnal death syndrome (SUNDS)." in the epidemiology section. Doc James (talk · contribs · email) 17:33, 15 February 2019 (UTC)

The history text which you sought to remove, and was justified by the presence by half a dozen references. Yanping Nora Soong (talk) 17:50, 15 February 2019 (UTC)

Okay so you insist upon using the three primary sources you mentioned? Rather than using recent secondary sources to support the text in question? Well I oppose than. Doc James (talk · contribs · email) 18:45, 15 February 2019 (UTC)

The AHA source is a secondary source, and ties the primary sources together. Yanping Nora Soong (talk) 23:43, 16 February 2019 (UTC)

Okay so do you plan to use it instead of the primary sources? Doc James (talk · contribs · email) 16:24, 17 February 2019 (UTC)

I still plan to include the other sources, since they're tied together by AHA secondary source. Yanping Nora Soong (talk) 17:02, 21 February 2019 (UTC)

We generally just use the secondary sources and not the primary sources. Doc James (talk · contribs · email) 21:49, 21 February 2019 (UTC)

The works are directly or indirectly referred to (through intervening sources) -- for example, I see no reason to exclude the original 1917 citation, for the curious reader. Yanping Nora Soong (talk) 23:09, 21 February 2019 (UTC)

That's something I always found interesting about Wikipedia; that is, being able to find some citations to the primary sources intertwined to secondary sources, which often cite that same primary source anyway. If your AHA secondary source discusses/analyses/synthesizes the results of those primary sources, I do not see the relevance of including them, unless you believe the secondary source is weak, perhaps through the inclusion of weak primary sources. Just my two cents on sources. Spyder212 (talk) 00:18, 22 February 2019 (UTC)

I'm a researcher / (new) grad student / premed (and sort of long-term patient who brings medical literature to her medical providers), and I've always found primary sources attached to secondary sources extra helpful. Yes, we should write for a general audience, but we shouldn't exclude a technical audience or informed lay audience either. Yanping Nora Soong (talk) 18:15, 22 February 2019 (UTC)

It's awesome to have you as a contributor! Is there any way I can see the way you use those primary sources in the text? It's one thing to have primary sources support claims in the text and yet another to simply put them next to a secondary source that cites them anyway. Generally, those who want to have access to primary sources know that they can simply go through the secondary source and find supporting literature there. And if they are not aware of this, then we would not necessarily want them to fall upon primary sources that have not yet been analyzed in light of other findings, which may support or contradict the results. Spyder212 (talk) 18:27, 22 February 2019 (UTC)

Talk page references

References