0439 : Incidence of inappropriate ICD shocks and other complications in asymptomatic versus symptomatic Brugada syndrome

Abstract

Brugada syndrome (BrS) requires implantation of cardioverter- defibrillator (ICD) to prevent sudden cardiac death. However, the ICD indications in asymptomatic patients are remain conflicting. We compared the rate of ICD complications in asymptomatic versus symptomatic BrS patients. ICD interrogations were done every 3-6 months. Given the low prevalence of BrS in the general population, 10% of the risk a?for the bilateral statistical test significance was chosen. We studied 51 patients, 86.5% male; mean age 4711 years at diagnosis. At diagnosis, 18 patients (35%) were asymptomatic, 25 patients (49%) experienced syncope, and 8 patients (16%) had been resuscitated from ventricular fibrillation. During a mean follow-up of 78±months, none of asymptomatic patients experienced appropriate therapy, whereas 21.6% of symptomatic patients had =1 shocks. Overall complication rate was 27.4%. Inappropriate shocks (IS) occurred in 7 patients (13.7%; mean 6.57±4 shocks per patient), 16.14±38 months after ICD implantation, and lead fracture was the first cause (n=4, 57.1%). The incidence of IS was higher in the asymptomatic patients (p=0.09). Device-related complications were similar in both groups (p=1). A total of 14 patients (27.4%) had =1 complications. The mean interval from implantation to a complication was 13.91±98 months. The most frequent complication was lead failure in 9 (17.6%). The risk of IS and device-complications at 3 years was 13.7% and 21.6% respectively, and eventually remains constant over the time. This study demonstrated that ICD has a high risk of complications, mainly during the early period after the device implantation. A higher rate of IS as well as a very low risk of arrhythmic events in asymptomatic BrS patients advocate to carefully evaluate this young and otherwise “healthy” population for the decision-making.