219 Follow-up of Brugada syndrome patients without implantable cardioverter-defibrillator: the “Achilles’ heel” of current studies?

Abstract

Risk stratification for sudden cardiac death in asymptomatic Brugada syndrome (BS) patients is not perfect. Although follow-up of patients with an implantable cardio-defibrillator (ICD) is reliable, follow-up for patients without an ICD is less accurate. All patients seen at the Bordeaux CHU between 1999 and 2009 with BS (spontaneous type 1 or after flecainide or ajmaline test) were included prospectively in the database, i.e. 187 patients (76% men, 44 ±12 years). Follow-up of non-implanted patients was carried out by consultation or annual telephone contact. All patients seen over the last 6 months were recontacted for this study. One hundred and two patients (55% BS, 76% men, 43 ±13 years) did not have an ICD. In 50% of cases the BS had been discovered by chance, after lipothymia or syncope in 32% of cases and during family assessment in 18% of cases. A spontaneous type 1 was present in 68%. Electrophysiological Study (EPS) had been carried out in 79% of patients (Negative in 75 pts and positive in 5pts who had refused the ICD). Average follow-up was 52 ±37 months, and no subject was lost to follow-up (follow-up<6months for all patients), 89 were asymptomatic, 7 presented with lipothymia, 1 with syncope (without arrhythmia on loop recorder), 1 had supra-ventricular tachycardia and 3 had died (septic shock, overdose, and one young patient called in for a family assessment died suddenly, even though his EPS was negative). After an exhaustive 4.3 year follow-up, 3/102 patients with BS and with no ICD had died, 1 suddenly, despite following risk stratification recommendations.