To the Editor,
We read with interest the comments on our recent review of the European Society of Cardiology (ESC) 2010 guidelines for the management of atrial fibrillation (AF).1 As the authors of the letter point out, there have been several reports of Brugada syndrome being unmasked when class IC antiarrhythmic drugs (flecainide, propafenone) are used to treat AF. However, the proportion of cases detected in such circumstances is not high. From a total of 613 patients, we identified 11 patients with Brugada syndrome (1.8% of all cases with AF), while Pappone et al.2 diagnosed the syndrome in 11 (3%) of 356 cases of new-onset AF. That is presumably why the ESC guidelines did not make any recommendations on this aspect of the condition, and why we did not do so in our article. However, we agree with the authors that a diagnosis of Brugada syndrome leads to a need for specific treatment alternatives, and that clinicians should be alert to the emergence of typical electrocardiographic changes when treating AF patients with class IC antiarrhythmic drugs.
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Corresponding author: manuelp.anguita.sspa@juntadeandalucia.es