Abstract
Implantation of a cardioverter defibrillator (ICD) is a frequently recommended treatment for symptomatic Brugada syndrome (BrS). However, complications related to the device have been reported. We assessed the benefit / morbidity ratio of this mode of therapy in a cohort of 34 patients implanted in 3 French experienced centers between January 1, 2002 and November 30, 2010. The mean age was 48±14 years, 4 (12%) female. Twenty nine (85%) patients had spontaneous typical coved Type I ECG pattern, 15 (44%) had family history of sudden cardiac death (SCD) and 24 (88%) had positive EP study. ICD implantation was based on aborted sudden cardiac arrest (SCA) in 3 (9%), syncope in 19 (56%) or high risk status (spontaneous type 1 ECG in conjunction with a family history of SCD and/or a positive EP study) in 12 (35%). The median follow-up period was 74±23 (9-127) months. One patient with prior cardiac arrest died of a non-cardiac cause, 5 (15%) patients had appropriate device therapy; all with spontaneous type I ECG and previous syncope but none with prior cardiac arrest. Overall complication rate was 26%. Six (27%) symptomatic and 3 (25%) asymptomatic patients experienced complications. Five (14%) patients (4 with previous syncope and 1 asymptomatic) experienced inappropriate shocks and 4 (12%) had other complications: 2 patients had lead rupture, 1 lead displacement, and 1 pneumothorax during device replacement. These complications occurred in 2 asymptomatic and 2 symptomatic (1 syncope and 1 prior aborted SCA) patients. No case of SCD was observed in ICD carriers. Appropriate device therapy after a median follow-up period of 6 years was observed in patients with prior syncope and none in asymptomatic patients. Complication rate was leading not to recommend ICD implantation in asymptomatic Brugada patients and to carefully evaluate the risk /morbidity ratio in subject with non spontaneous coved type ECG pattern.
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