The treatment of choice is an indwelling defibrillation. The question is who should receive it. The most controversial issue is the value of electrophysiological study as an indicator of prognosis. Studies from Priori et al., Kanda et al., and Eckardt et al. have not found an association between inducibility and recurrence of events. Our data of close to 700 patients indicate that EP study inducibility is prognostic of risk. The use of electrophys-iological data is probably not clinically necessary in the patient who has recovered from sudden cardiac death. These patients require a defibrillator. The controversy is how aggressive to be with asymptomatic patients. There is no doubt that asymptomatic patients are also at risk. Brugada syndrome generally affects individuals in their 40s, despite the fact that the genetic predisposition is present since birth. What determines the likelihood of a patient becoming symptomatic is at present unknown. Unfortunately, all symptomatic patients were previously asymptomatic for many years. Identifying which group will become symptomatic is a critically important preventative measure. Our group has shown that asymptomatic patients who are inducible have a 14 % chance of having an event. If they are noninducible they have less than a 2% of chance of having an event. We therefore advocate the implantation of a defibrillator in asymptomatic inducible patients. The remainder require close follow-up until evidence-based data provide further guidance for risk stratification.
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The use of dumbbells gives you a much more comprehensive strengthening effect because the workout engages your stabilizer muscles, in addition to the muscle you may be pin-pointing. Without all of the belts and artificial stabilizers of a machine, you also engage your core muscles, which are your body's natural stabilizers.