Brugada syndrome: does syncope has prognostic impact?

Abstract

Introduction: Brugada Syndrome (BS) is associated with increased risk of Sudden Cardiac Death (SCD). Risk stratification of BS patients remains controversial and recommendations for implantable cardioverter-defibrillator (ICD) implantation is not well established. Our aim was to evaluate long-term prognosis of BS patients with ICD implanted and to identify the predictors of appropriate shocks. Methods and results: Fifty-five consecutive patients (age 41.7±13.8 years; 81.8% male) with BS, of whom 36 (65.5%) implanted an ICD, were included. Twenty-five (69.4%) patients had spontaneous Type 1 Electrocardiogram (ECG) pattern, 17 (47.2%) were symptomatic [syncope 11 (30.6%) and aborted SCD 6 (16.7%)] and 14 (38, 9%) had family history of SCD. During the mean follow-up of 74±40 months (>5 years in 72% patients), 7 (19.4%) patients experienced appropriate shocks. These patients had most frequently aborted SCD (54.1% vs. 6.9%, p=0.008) and non-sustained ventricular tachycardia episodes (57.1% vs. 10.3%, p=0.016) during the follow-up. Spontaneous Type 1 ECG pattern and syncope were not significantly associated with the occurrence of these events. By multivariate analysis (Cox regression), aborted SCD was an independent predictor of appropriate shocks (HR 8.07 95% CI 1.58 to 41.2, p=0.012). Receiver operating characteristic analysis showed a moderate discriminatory power of aborted SCD to predict appropriate shocks - area under curve 0.751, sensitivity 57% and specificity 93% (Table 1). View this table: Table 1. Predictive value of different characteristics for appropriate shocks Conclusions: In this population of patients with Brugada syndrome and ICD implanted, the rate of appropriate shocks at long-term was low. Aborted sudden cardiac death was associated with higher risk, while syncope and spontaneous Type I ECG pattern were not predictors of appropriate shocks.