Identification of Brugada Syndrome as a Quality Control Test for EMF Danger for Affected Individuals with and without Implanted Devices or Unaware of their Condition
DOI:
https://doi.org/10.14738/bjhr.1302.20235Keywords:
Brugada syndrome, active implantable medical devices (AIMD), electromagnetic fields (EMF)Abstract
We report three cases of workers with Brugada syndrome (BrS) who were fitted with an active implantable medical device (AIMD) with a defibrillator effect. In these individuals, abnormalities in sodium ion channels are the cause of acute ventricular fibrillation attacks. While the fundamental role of ICD therapy in preventing fatal arrhythmias in Brugada syndrome is obvious, device-related complications cannot be ruled out, especially in younger, working-age patients, even in cases where thoracoscopic epicardial ablation was performed in addition to the ICD with a positive outcome. However, while it is obvious in these individuals, limiting or excluding excess exposure to electromagnetic field (EMF) sources or other incompatibilities with the routine performance of certain tasks is necessary, based on necessary precautions. However, it appears difficult to diagnose Brugada syndrome or other channelopathies in subjects without device use and with an unresolved medical history, or to rule out the effect of exposure to (EMF) in those with unrecognized Brugada syndrome. The goal of this study is to clarify which specific measures could be adopted, whether they are sufficient in the most severe conditions, and whether precautionary procedures allow for continued work. Finally, it is also important to clarify a larger clinical study in the preventive phases.
References
Brugada P, Brugada J. Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome. A multicenter report. J Am Coll Cardiol. 1992 Nov 15; 20(6):1391-6. doi: 10.1016/0735-1097(92)90253-j. Scholar Publishing
Brugada R, Campuzano O, Sarquella-Brugada G, Brugada P, Brugada J, Hong K. Brugada Syndrome. 2005 Mar 31 [updated 2022 Aug 25]. In: Adam MP, Feldman J, Mirzaa GM, Pagon RA, ® Wallace SE, Amemiya A, editors. GeneReviews [Internet]. Seattle (WA): University of Washington, Seattle; 1993–2025. Online at: https://www.ncbi.nlm.nih.gov/books/.
Brugada J, Campuzano O, Arbelo E, Sarquella-Brugada G, Brugada R. Present Status of Brugada Syndrome: JACC State-of-the-Art Review. J Am Coll Cardiol. 2018 Aug 28; 72(9):1046-1059. doi: 10.1016/j.jacc.2018.06.037.
Pappone C, Santinelli V. Brugada Syndrome: Progress in Diagnosis and Management. Arrhythm Electrophysiol Rev. 2019 Mar; 8(1):13-18. doi: 10.15420/aer.2018.73.2.
Pérez Riera AR, Antzelevitch C, Schapacknik E, Dubner S, Ferreira C. Is there an overlap between Brugada syndrome and arrhythmogenic right ventricular cardiomyopathy/ dysplasia? J Electrocardiol. 2005 Jul; 38(3):260-3. doi: 10.1016/j.jelectrocard.2005.03.009.
Moncayo-Arlandi J, Brugada R. Unmasking the molecular link between arrhythmogenic cardiomyopathy and Brugada syndrome. Nat Rev Cardiol. 2017 Dec; 14(12):744-756. doi: 10.1038/nrcardio.2017.103.
Probst V et al. Progressive cardiac conduction defect is the prevailing phenotype in carriers of a Brugada syndrome SCN5A mutation. J Cardiovasc Electrophysiol. 2006 Mar; 17(3):270-5. doi: 10.1111/j.1540-8167.2006.00349.x.
Shimizu W. Does an overlap syndrome really exist between Brugada syndrome and progressive cardiac conduction defect (Lenegre syndrome)? J Cardiovasc Electrophysiol. 2006 Mar; 17(3):276-8. doi: 10.1111/j.1540-8167.2006.00406.x.
Kotta CM, Anastasakis A, Stefanadis C. Effects of mutations and genetic overlap in inherited long-QT and Brugada arrhythmia syndromes. Hellenic J Cardiol. 2012 Nov-Dec; 53(6):439-46.
Nakaya H. SCN5A mutations associated with overlap phenotype of long QT syndrome type 3 and Brugada syndrome. Circ J. 2014; 78(5):1061-2. doi: 10.1253/circj.cj-14-0319.
Erdoğan O. Coexistence of Wolff-Parkinson-White and Brugada ECG. Turk Kardiyol Dern Ars. 2018 Sep; 46(6):433-434. doi: 10.5543/tkda.2018.75271.
Monasky MM, Ciconte G, Anastasia L, Pappone C. Commentary: Next Generation Sequencing and Linkage Analysis for the Molecular Diagnosis of a Novel Overlapping Syndrome Characterized by Hypertrophic Cardiomyopathy and Typical Electrical Instability of Brugada Syndrome. Front Physiol. 2017 Dec 12;8:1056. doi: 10.3389/fphys.2017.01056.
Hothi SS, Ara F, Timperley J. p.Y1449C SCN5A mutation associated with overlap disorder comprising conduction disease, Brugada syndrome, and atrial flutter. J Cardiovasc Electrophysiol. 2015 Jan; 26(1):93-7. doi: 10.1111/jce.12470.
Francis J, Antzelevitch C. Atrial fibrillation and Brugada syndrome. J Am Coll Cardiol. 2008 Mar 25; 51(12):1149-53. doi: 10.1016/j.jacc.2007.10.062.
Vlachos K, et al. Atrial fibrillation in Brugada syndrome: Current perspectives. J Cardiovasc Electrophysiol. 2020 Apr; 31(4):975-984. doi: 10.1111/jce.14361.
Parisi P, et al. Coexistence of epilepsy and Brugada syndrome in a family with SCN5A mutation. Epilepsy Res. 2013 Aug; 105(3):415-8. doi: 10.1016/j.eplepsyres.2013.02.024.
Abdelghani MS, Chapra A, Asaad N, Hayat SA. Epilepsy and Brugada Syndrome: Association or Uncommon Presentation? Heart Views. 2020 Apr-Jun; 21(2):114-117. doi: 10.4103/HEARTVIEWS.HEARTVIEWS_34_20.
Monasky MM, Micaglio E, Ciconte G, Pappone C. Brugada Syndrome: Oligogenic or Mendelian Disease? Int J Mol Sci. 2020 Mar 1; 21(5):1687. doi: 10.3390/ijms21051687. Scholar Publishing
GeneCards: The Human Gene Database. Available online at: https://www.genecards.org/.
D’Imperio S, Monasky MM, Micaglio E, Ciconte G, Anastasia L, Pappone C. Brugada Syndrome: Warning of a Systemic Condition? Front Cardiovasc Med. 2021 Oct 15; 8:771349. doi: 10.3389/fcvm.2021.771349.
International Commission on Non-Ionizing Radiation Protection (ICNIRP). Guidelines on limits of exposure to static magnetic fields. Health Phys. 2009 Apr;96(4):504-14. doi: 10.1097/01.HP.0000343164.27920.4a.
International Commission on Non-Ionizing Radiation Protection (ICNIRP). Guidelines for limiting exposure to electric fields induced by movement of the human body in a static magnetic field and by time-varying magnetic fields below 1 Hz. Health Phys. 2014 Mar;106(3):418-25. doi: 10.1097/HP.0b013e31829e5580.
International Commission on Non-Ionizing Radiation Protection (ICNIRP). Guidelines for limiting exposure to time-varying electric and magnetic fields (1 Hz to 100 kHz). Health Phys 2010 Dec; 99(6): 818-36. doi: 10.1097/HP.0b013e3181f06c86. Figures 1 and 2 have been adapted with permission from Wolters Kluwer Health, Inc.
International Commission on Non-Ionizing Radiation Protection (ICNIRP). Guidelines for Limiting Exposure to Electromagnetic Fields (100 kHz to 300 GHz). Health Phys. 2020 May; 118(5):483-524. doi: 10.1097/HP.0000000000001210.
Directive 2013/35/EU of the European Parliament and of the Council of 26 June 2013 on the minimum health and safety requirements regarding the exposure of workers to the risks arising from physical agents (electromagnetic fields) Official Journal of the European Union L-179 1
Sohinki D, Thomas J, Scherlag B, Stavrakis S, Yousif A, Po S, Dasari T. Impact of low-level electromagnetic fields on the inducibility of atrial fibrillation in the electrophysiology laboratory. Heart Rhythm O2. 2021 Apr 30;2(3):239-246. doi: 10.1016/j.hroo.2021.04.004
Saxena A, Jacobson J, Yamanashi W, Scherlag B, Lamberth J, Saxena B. A hypothetical mathematical construct explaining the mechanism of biological amplification in an experimental model utilizing picoTesla (PT) electromagnetic fields. Med Hypotheses. 2003 Jun; 60(6):821-39. doi: 10.1016/s0306-9877(03)00011-2
Moras E, Gandhi K, Narasimhan B, Brugada R, Brugada J, Brugada P, Krittanawong C. Genetic and Molecular Mechanisms in Brugada Syndrome. Cells. 2023 Jul 5; 12(13):1791. doi: 10.3390/cells12131791
Broser PJ, Middelmann T, Sometti D, Braun C. Optically pumped magnetometers disclose magnetic field components of the muscular action potential. J Electromyogr Kinesiol. 2021 Feb;56:102490. doi: 10.1016/j.jelekin.2020.102490
Zuo S, Schmalz J, Ozden MO, Gerken M, Su J, Niekiel F, Lofink F, Nazarpour K, Heidari H. Ultrasensitive Magnetoelectric Sensing System for Pico-Tesla MagnetoMyoGraphy. IEEE Trans Biomed Circuits Syst. 2020 Oct;14(5):971-984. doi: 10.1109/TBCAS.2020.2998290.
Zhu K and Kiourti A. A Review of Magnetic Field Emissions From the Human Body: Sources, Sensors, and Uses IEEE Open Journal of Antennas and Propagation, 2022 July 3:732-744. doi: 10.1109/OJAP.2022.3186643.
K. Zhu and A. Kiourti. “A Review of Magnetic Field Emissions from the Human Body: Sources, Sensors, and Uses” in IEEE Open Journal of Antennas and Propagation, vol. 3, pp. 732-744, 2022, doi: 10.1109/OJAP.2022.3186643 Scholar Publishing
EN 50527-1:2016 standard, “Procedure for the assessment of the exposure of workers to electromagnetic fields”
EN 50499:2020 standard, “Procedure for the assessment of the exposure of workers to electromagnetic fields”
Giudicessi JR et al. Transient Outward Current (Ito) Gain-of-Function Mutations in the KCND3-Encoded Kv4.3 Potassium Channel and BrugadaSyndrome Heart Rhythm. 2011 July; 8 (7):1024–1032. doi:10.1016/j.hrthm.2011.02.021
He Q, Feng Y, Wang Y. Transient outward potassium channel: a heart failure mediator Heart Fail Rev 2015 May; 20 (3):349-62. doi: 10.1007/s10741-015-9474-y
Brodie OT, Michowitz Y, Belhassen B. Pharmacological Therapy in Brugada Syndrome Arrhythm Electrophysiol Rev. 2018 Jun; 7 (2):135–142, doi: 10.15420/aer.2018.21.2
Brugada R et al. Sudden Death Associated With Short-QT Syndrome Linked to Mutations in HERG 2004 Circulation 2004 Jan; 109 (1): 30-5, doi: 10.1161/01.cir.0000109482.92774.3A
EN 50527-2-1:2016 standard, “Procedure for the assessment of the exposure to electromagnetic fields of workers bearing active implantable medical devices - Part 2-1: Specific assessment for workers with cardiac pacemakers”
EN 12983-1:2023 standard, “Cookware - Domestic cookware for use on top of a stove, cooker or hob - Part 1: General requirements”
Guldimann R and Meier M. Magnetic field exposure from professional induction cookers – Health protection at work 2009-2010 Staatssekretariat für Wirtschaft SECO – Switzerland https://www.seco.admin.ch/seco/de/home/seco/nsb-news/medienmitteilungen-2011.msgid-42099.html
Modenese, A. Gobba, F. Occupational Exposure to Electromagnetic Fields and Health Surveillance according to the European Directive 2013/35/EU. Int. J. Environ. Res. Public Health 2021, 18, 1730. doi: 10.3390/ijerph18041730
Gu F, Han J, Laden F, Pan A, Caporaso NE, Stampfer MJ, Kawachi I, Rexrode KM, Willett WC, Hankinson SE, Speizer FE. Schernhammer ES. Total and cause-specific mortality of U.S. nurses working rotating night shifts. Am J Prev Med. 2015 Mar;48(3):241-52. doi: 10.1016/j.amepre.2014.10.018
Sabo M, Kopani M. Computational study of endogenous magnetic particles' effect on action potential processing in a Purkinje cell model Bratisl Lek Listy 2024;125(12):766-774. doi: 10.4149/BLL_2024_117.
Candura S M, Vanoli D, Mazzanti L, D’ Amato S G Priori, Scafa F, Brugada syndrome and job fitness: report of three cases Industrial Health 2023, 61(6), 455-461 DOI: 10.2486/indhealth.2022-0205.
Zheng Z, Zhiwen Z, Yongfeng L, Wei W, Ying W, Jiuping D Kinetic model of Nav1.5 channel provides a subtle insight into slow inactivation associated excitability in cardiac cells PLoS One 2013 May 16;8(5):e64286. doi: 10.1371/journal.pone.0064286.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Mauro Mazzotta, Manuel Fernandez, Alessandro Dario Mazzotta, Rocco Giuseppe Cazzato
This work is licensed under a Creative Commons Attribution 4.0 International License.
