Exploration of the Role of Cilostazol in Brugada Syndrome: Mechanisms, Therapeutic Potential, and Implications in the Prevention of Ventricular Arrhythmias

Despite the relatively low incidence of Brugada syndrome (BrS) globally, the risk of sudden cardiac death remains alarmingly high, reaching rates of up to 28%. According to current clinical guidelines, implantable cardioverter defibrillators (ICDs) are recommended for high-risk patients. Meanwhile, pharmacological interventions must be used as a backup owing to the limited access to ICDs by eligible patients. Cilostazol, an adenosine uptake inhibitor and phosphodiesterase III inhibitor, has been suggested to reduce the risk of ventricular arrhythmias in BrS patients by stabilizing the action potential dome and lowering the epicardial-to-endocardial repolarization gradient, consequently decreasing the probability of phase II re-entry. However, the effectiveness of cilostazol in this situation has been questioned due to the existence of contradictory results from different case reports. Thus, this literature review aims to synthesize current evidence regarding the potential of cilostazol to lower the risk of ventricular arrhythmias in patients with BrS.