Doctor assures Flanders’ global influence in cardiology

Summary

Drawing some of the world’s best technology and talent, pioneering cardiologist Pedro Brugada has made Brussels and Flanders a hotbed of cardiology research

Brugada Syndrome named after go-to doctor for heart conditions

Pedro Brugada insists he never sought the label, even if it earned him an extremely rare distinction as a doctor: having a syndrome named after him. Brugada Syndrome – first coined by Japanese researchers to describe the hereditary heart rhythm disorder the doctor wrote about two decades ago – has stuck as a term.

The pioneering Spanish-born cardiologist (pictured), who has headed the heart rhythm management centre at the University Hospital Brussels (UZ Brussel) since 2006, recognises that this is probably how history will remember his name. “It has made me well-known, of course,” he tells me, “but what’s more important is that it has helped raise awareness of heart conditions and has stimulated research.”

Brugada Syndrome can be fatal, causing an apparently healthy person to go into cardiac arrest. Identifying it has ensured Brussels’ global influence in cardiology. Thanks to his high profile, Brugada, who has lived in Aalst since 1991, has been able to bring some of the world’s best technology and talent to local hospitals, clinics and research centres.

And it has brought in a number of big-name footballers since the 59-year-old became the go-to doctor for heart conditions. This includes former Bolton Wanderers midfielder Fabrice Muamba, whose heart dramatically stopped for more than an hour during a game last year, and former Senegal and Inter Milan striker Khalilou Fadiga, who suffers from an extrasystole, which means his heartbeat can be irregular.

Closer to home, he is credited with saving the life – and career – of KV Mechelen’s Anthony Van Loo, who he fitted with a defibrillator in 2008 when the young star was diagnosed with a life-threatening heart condition. 

Learning Dutch

So, how did this Spaniard professor end up in Flanders, turning the region into a hothouse for cardiology? Brugada himself attributes it to chance. 

My wife was pregnant, and I needed a job

- Pedro Brugada

His father once tried to groom him to take over the family farm, but his mother insisted he should study. At one point, the young Pedro considered music at the local conservatory; later he thought of studying art since he was a decent oil painter. In the end, he opted for philosophy and medicine at the University of Barcelona.

After excelling in his first-year exams, he moved to an elite research stream at the pharmacology department, giving him an early experience of laboratories. He eventually graduated magna cum laude. He wanted to work in the haematology department, studying blood, but he couldn’t afford the required extra school year.

“My wife was pregnant, and I needed a job. So that is how I ended up as a cardiologist; a position was immediately available,” he says. “But when you look at medicine, every single discipline is so beautiful. It doesn’t matter if you do gastroenterology, pharmacology, cardiology or surgery.”

Two years later, Brugada felt ready to return to research. He moved to Maastricht University, which already had a well-established reputation for cardiology. He learned Dutch and in 1986 became a cardiology professor. The language proved critical in his next move – in 1990 to Aalst, which had become an emerging cardiology centre.

Brugada was invited to create an electrophysiology laboratory – studying the electrical properties of biological cells and tissues –in the cardiology department of Aalst’s Onze-Lieve-Vrouw Hospital. 

In 2006, UZ Brussel approached him. “Again, a similar story,” he says, “a move to create something that they didn’t have. It is now one of the leading centres for clinical physiology in the world, with one of the world’s most technologically advanced cardiology departments.” 

Strange abnormalities

At UZ Brussel, he oversees the work of 200 people. Brugada still lives in Aalst and has a private clinic there. In the meantime, some 32 centres in Belgium for electrophysiology have been set up, many created by Brugada or by people who worked and trained in his department in Aalst.

Now we hear of one new family with the Brugada Syndrome every week

- Pedro Brugada

It was in Maastricht in 1987, that Brugada encountered the first patients with the syndrome that now bears his name. A Polish man brought his three-year-old son to see him, who had a history of repeated episodes of fainting and cardiac arrest. The boy’s electrocardiogram (ECG) had strange abnormalities, and Brugada’s curiosity was piqued. So he asked the father, who was returning to Poland, for electrocardiograms of the boy’s sisters. “They had the same abnormalities,” he says. “And so did the father.”

Over the next four years, Brugada – with his brother Josep, then working alongside him – found more patients with similar conditions and discussed it with other doctors. By 1992, with eight documented patients, they published the findings in the Journal of the American College of Cardiology, describing it as a distinct clinical entity. Further patients were discovered, and in 1996, a Japanese paper on the issue first described it as the Brugada Syndrome.

“What has happened since has been incredible,” Brugada says. “We initially thought of it as a curiosity, a nice paper, that is it, with not much wider relevance. Now we hear of one new family with the Brugada Syndrome every week.”

Brugada describes the syndrome as caused by ventricular fibrillation – when there is unco-ordinated contraction of the cardiac muscle of the heart’s ventricles. “In every other way it could be a completely normal heart – at the coronary arteries, the muscles, valves – but the electricity is a problem,” he explains.

The oldest person he found with the syndrome was 87, proving that it does not necessarily cut short someone’s life. He has also found that some drugs, like malaria pills, can trigger it, as well as fever, as some of the activators in the DNA are heat-driven. 

Malign spirits

He emphasises that the attacks usually happen outside of sport. Most patients actually have attacks at night; they tend to die in their sleep. “It happens when stress and adrenalin levels decrease,” explains Brugada. “So adrenalin in fact protects you.” 

Twelve is a very important age to start teaching children about health

- Pedro Brugada

Indeed, it is no coincidence that the Japanese were the ones to coin the term Brugada Syndrome, as it is thought to be closely linked to sudden unexpected death syndrome (SUNDS), which is particularly prevalent in East Asia. Named Lai Tai in Thailand, meaning "sleep and die”, and Pokkuri in Japan, there is even a folk legend in Laos ascribing the deaths to a malign spirit said to take the form of a jealous woman.

Brugada today deals with the whole spectrum of heart issues, including raising public health awareness. A former smoker, he says prevention of cardiovascular disease should begin as early as 12 years old. “Twelve is a very important age to start teaching children about health, safety, diet and other issues,” he says. “They need to change their lifestyle. At 14 or 15, it’s too late; they may have already started smoking, sitting in front of the TV and eating hamburgers.”

Brugada still works with his brother Josep, at the University of Barcelona, as well as his third brother, Ramon, at the University of Girona. In 2000, the brothers discovered another genetically determined arrhythmia – short-QT syndrome – and they later succeeded in describing the genetic defect responsible. And he is trying to set up a Brugada Foundation in Belgium; there is already one in Spain.

And now Brugada is dabbling in politics, last year elected as an Open VLD city councillor for Lede, in East Flanders. He says the position is mainly to help the local agency of the social help office OCMW – where he is the vice-president – to pursue projects for the poor.  

www.brussels-chvz.be

Photo credit: Bart Dewaele / imagedesk.be