LETTER TO EDITOR

Letter to comment the article: Tonussi Mendes JE, Nikus k, Barbosa-Barros R, Pérez-Riera AR. The numerous denominations of the Brugada syndrome and proposal about how to put an end to an old controversy - a historical-critical perspective. J Hum Growth Dev. 2020; 30(3):480-491

Bortolo Martini M.D

Director (retired), Cardiac Unit, Alto Vicentino Hospital Via Gioberti 9 36016 Thiene (VI), Italy

Correspondence

Réddite quae sunt Caésaris Caésari et quae sunt Dei Deo . (Matthew 22:21 Jesus said "Render to Caesar the things that are Caesar's; and to God the things that are God's). A word of fairness please!

Doctor Andrea Nava, 1938-2018¹ and not myself , associate Cardiologist at the University of Padova, Italy, first discovered the Precordial early repolarization syndrome (PERS)², simply analyzing the clinical and electrocardiographic (ECG) patterns of a single patient. Incidentally, many Medical discovers derived from a single case observation by some wise physician and not from guidelines, conferences or literature reviews. Two more patients with a similar ECG were reported a year later³. His open mind analysis proposed that the ecg pattern was related to a conduction disturbance at the right ventricular outflow tract level, possible related to some structural right heart abnormalities. After 33 years of heavy debate (and personal derision and threats), insisting that a functional heart disease, a repolarization abnormality and a diseased sodium channel were the absolute true, nowadays many outstanding authorities have "re-discovered e re-published" the Nava theories, so often without any fair citation. The recent paper by Joseane Elza Tonussi Mendes⁴ propose to diminish or abolish his pivotal role, according to a self claimed authority and expertise.

Doctor Nava did not speak English, did not studied guidelines, was never invited to scientific meetings or to consensus conferences, and did not make any money out of his discovers, simply living on his pension. He never claimed that the PERS syndrome had not been fairly named Nava syndrome. He also first discovered the electro-vectocardiographic patterns of an atypical right bundle block pattern, of the re-entry circuit in the common type atrial flutter, the VDD pace-maker, the chromosomes and the genes underlying right ventricular cardiomyopathy. Gaetano Thiene, Gianfranco Buja, Bruno Canciani, Giandomenico Danieli, Alessandra Rampazzo, Barbara Bauce, Domenico Corrado, Luciano Daliento, Cristina Basso and many other enthusiastic young doctors followed his teaching. After his death, the same year of his friend Guy Fontaine, the outstanding contribution of Andrea Nava to the knowledge of cardiac arrhythmias belongs to the future history of Medicine, but as in many other diseases the less the scientific contribution of published paper, the more the Strauss law of eponyms is extensively applicated

Medicine is not yet a science but still rely on individual intuitions. The true outstanding Doctors are more artists than scientists, but this not well accepted and so often "politics penetrates basic science" as wisely written by one on the discover of the SCN5A channels sometime related to the PERS syndrome.

The Brazilian group, has recently renewed their long lasting interest in the polemic to attribute a friendly eponym to this syndrome, with a tribute to the Brugada Brothers, whose contribution to the knowledge of the syndrome is out of discussion. To demonstrate this self-refenced assumption they insist to minimize the papers written by Nava and myself, trying to demonstrate that in their opinion, only one case truly fitted with a consensus definition established in 2013, twenty five years after the initial discovery. They probably are not aware of other papers that discussed the topic^6-8 and they principally should know that type one ecg is not "mandatory for the diagnosis of the syndrome" but is simply the most popular ECG of the syndrome, but not the only one. In all published series, this spontaneous ECG pattern belongs to the minority of cases classified as syndrome.

This anxiety to be the first who says something, has led to a worldwide blameful overestimation of the importance of the ECG in identifying true patients at risk, but the result of this rush is that so many healthy asymptomatic people have been submitted to invasive investigations and therapy, only because they something fitted with a type ,3 ECG, with a high precordial leads ECG recording, with some inconclusive drug challenge, mostly performed by unexperienced doctors, who only believed to a consensus that is nowadays under relevant discussion, according to new increasing evidences.

I totally disagree to insist with the polemic to try to differentiate two different but identical syndromes, with the only aim to preserve popular eponyms and self claimed authority. Medicine improvement is not a soccer match between Italy and Spain directed by a Brazilian referee, but a serious and evidence based humble contribution to the knowledge of disease. Professor Andrea Nava was our and everybody master of science and life and He discovered the PERS. A word of fairness and respect please!

REFERENCES

1.Martini B, Buja GF. In memoriam Andrea Nava M.D. (1938-2018), associate professor of cardiology, University of Padova. Journal of Electrocardiology 51 (2018) 674-676        [ Links ]

2.Nava A, Canciani, B, Schiavinato ML, Martini B. La repolarisation precoce dans le precordiales droites: trouble de la conduction intraventriculaire droite? Correlations de l'electrocardiographie- vectorcardiographie avec l'electro-physiologie. Mises a Jour Cardiologiques. 1988; 17:157-9.         [ Links ]

3.Martini B, Nava A, Thiene G, et al. Ventricular fibrillation without apparent heart disease: description of six cases. Am Heart J. 1989; 118: 1203-9.         [ Links ]

4.Tonussi Mendes JE, Nikus k, Barbosa-Barros R, Pérez-Riera AR. The numerous denominations of the Brugada syndrome and proposal about how to put an end to an old controversy - a historical-critical perspective. J Hum Growth Dev. 2020; 30(3):480-491.         [ Links ]

5.Havakuk O, Viskin S. A tale of 2 Diseases: The History of Long-QT Syndrome and Brugada Syndrome. J Am Coll Cardiol. 2016 Jan 5;67(1):100-8        [ Links ]

6.Martini Martini B, Wu J, Nava A. A rare lethal syndrome in search of its identity: Sudden death, right bundle branch block and ST segment elevation. En: Wu J, Wu J, editors. Sudden death: Causes, risk factors and prevention., 1. Tampa, FL: Nova Biomedical; 2013. p. 2---39.         [ Links ]

7.Martini, B., Martini N., Dorantes Sánchezc M, Márquez M., Zhang L., Fontaine G., Nava A. : Pistas de una enfermedad orgánica subyacente en el síndrome de Brugada. Arch Cardiol Mex. 2017;87(1):49---60        [ Links ]

8.Martini B. Six young patients resuscitated from ventricular fibrillation between 1980-1989. Cardiopulse. In press        [ Links ]

Correspondence:
Bortolo Martini M.D.
bortolo.martini@gmail.com

Received: September 2020
Revised: September 2020
Accepted: September 2020