From picture of health to sudden cardiac death

It was a regular day in April, when the life of Davide Piccini changed forever. He was hurrying to catch his train home when he suddenly felt dizzy–losing consciousness and collapsing almost immediately. “My body suddenly just ‘switched off’ and I fell face down on the sidewalk. I broke several teeth in the fall,” he remembers. After been checked out at the nearby hospital, the Inselspital in Bern, he soon discovered that his teeth were the least of his worries. "I didn’t expect my fall to be because of something cardiac related. The diagnosis was completely unexpected.”

When he arrived at the hospital, he was given a thorough examination, but his clinical images gave no indication of his sudden syncope. Only when a young doctor looked at the 12-lead ECG that is routine in the ER and remembered a recent topic from their studies, were they able to confirm: The ECG indicated a pattern typical for Brugada syndrome, a disease that affects the electrophysiology of the heart. This is what had caused his syncope. He had to stay in the hospital to confirm the diagnosis through further tests.

Sudden cardiac arrest or sudden death is one of the risks associated with Brugada syndrome. In addition, the risk of syncope and life-threatening ventricular arrhythmias is very high in patients with this syndrome [3]. For Piccini, the event in April meant losing the illusion of having some sort of control over such events. He attended check-ups, knew about risk factors, and still wasn’t able to do anything to prevent the incident at the train station. “People usually think of cardiac disease in terms of coronary occlusion and lifestyle related consequences–but the heart is a very complex organ and cardiac diseases come in many forms,” he says.

Brugada is caused by a gene, as Pappone explains: “Family history is very significant. There is a very strong correlation between family history and the behavior of the disease in family members.” Many people who get the diagnosis know of male relatives who died young due to an unknown cause. The prevalence appears to be eight to ten times higher in men [4]. Therefore, the expert urges his patients to talk to their families about their diagnosis.

As Piccini realized from his own personal experience, with no indication of Brugada in his annual check-up ECGs, it wasn’t easy to diagnose the syndrome. Two-thirds of patients with Brugada have a normal ECG.

For cardiovascular conditions triggered by genetic predisposition, as well as other cardiovascular diseases, one thing is true: Something can be done. A healthy lifestyle is key. Regular physical activity, a balanced diet, and strategies for coping with stress are ways that people can avoid becoming cardiac patients. This is also why Piccini is telling his story–to make others aware of their heart health and take preventive measures. 

He hopes they can be spared the fear and uncertainty that comes with a cardiac incident. “I thought so much about my wife and kids–and what could have happened at the train station. And about my relatives who had grown up without a father or uncle because of Brugada being in the family.” At the same time, he is hopeful for the future, and knows he is lucky to live in a time where there are solutions to prevent future events.

Patient pathways and solutions in all areas of cardiology are evolving. Pappone can look back at significant progress in his field of electrophysiology: “Over the last ten years, we’ve had very good outcomes after ablation in Brugada cases. We have a program for screening patients, for assessing their risk, and for following up after the ablation.” 

Piccini concludes: “I really felt that if this had happened 20 years ago, it would have been completely different.” The incident showed him how much the work of Siemens Healthineers matters in supporting healthcare professionals. “I like the fact that, with the job I have, together with my colleagues, I can improve what’s out there for patients. For patients like me.”