Oral quinine sulfate for the treatment of electrical storm and prevention of recurrent shocks in Brugada syndrome after failed cilostazol therapy

Introduction Brugada syndrome (BrS), an inherited ion channelopathy with an autosomal mode of inheritance, is associated with an increased risk of ventricular fibrillation (VF) and sudden death in the young. Implantable cardioverter-defibrillator (ICD) is effective in terminating VF and preventing sudden cardiac arrest in high-risk BrS patients but does not prevent recurrences of VF. An electrical storm occurs in 5% of asymptomatic BrS patients and in 45% of patients who have survived sudden cardiac arrest. Isoproterenol infusion is effective in suppressing VF episodes during electrical storms in BrS patients. Quinidine, a class IA drug, is effective in preventing recurrences of ventricular tachycardia (VT) and VF in a patient with BrS. However, quinidine is not available in most countries around the world, especially in Southeast Asia, where the disease is more prevalent. We present a case of BrS with an electrical storm while on therapy with oral cilostazol and discuss the management with oral quinine sulfate.