Abstract
Background: Male gender has been consistently shown to be a risk factor for a greater number of arrhythmic events in patients with Brugada Syndrome (BrS). However, there have been no large-scale comprehensive pooled analyses to statistically and systematically verify this association. Therefore, we conducted a pooled analysis on gender differences in prognosis and risk stratification of BrS with a largest sample capacity at present.Methods: We searched PubMed, Embase, Medline, Cochrane Library databases, Chinese National Knowledge Infrastructure, and Wanfang Data for relevant studies published from 2002 to 2017. The prognosis and risk stratification of BrS and risk factors were then investigated and evaluated according to gender.Results: Twenty-four eligible studies involving 4,140 patients were included in the analysis. Male patients (78.1%) had a higher risk of arrhythmic events than female patients (95% confidence interval: 1.46–2.91, P < 0.0001). Among the male population, there were statistical differences between symptomatic patients and asymptomatic patients (95% CI: 2.63–7.86, P < 0.00001), but in the female population, no statistical differences were found. In the female subgroup, electrophysiological study (EPS) positive patients had a tendency toward a higher risk of arrhythmic events than EPS-negative patients (95% CI: 0.93–29.77, P = 0.06).Conclusions: Male patients are at a higher risk of arrhythmic events than female patients. Within the male population, symptomatic patients have a significantly higher risk profile compared to asymptomatic patients, but no such differences are evident within the female population. Consequently, in the female population, the risk of asymptomatic patterns cannot be underestimated.
Highlights
Brugada syndrome (BrS) is an inherited arrhythmic disorder generally characterized by a distinct electrocardiogram (ECG) pattern: the presence of ST-segment elevation in the right precordial leads (V1–V3), which may carry an increased risk of sudden cardiac death (SCD) due to malignant ventricular arrhythmias (Bayés et al, 2012)
All studies had to meet following criteria for inclusion: (a) full-text English language studies published in peerreviewed journals; (b) prospective or retrospective observational study design; (c) follow-up duration sufficiently long to detect arrhythmic events; (d) information included regarding clearly defined endpoint events; (e) risk ratio (RR), hazard ratio (HR), odds ratio (OR), corresponding 95% confidence intervals (CIs), or necessary raw data were reported
In the female subgroup, electrophysiological study (EPS)-positive patients had a tendency toward a higher risk of arrhythmic events
Summary
Brugada syndrome (BrS) is an inherited arrhythmic disorder generally characterized by a distinct electrocardiogram (ECG) pattern: the presence of ST-segment elevation in the right precordial leads (V1–V3), which may carry an increased risk of sudden cardiac death (SCD) due to malignant ventricular arrhythmias (Bayés et al, 2012). BrS was described as a functional abnormality of repolarization, but theory proposed by Nava et al believed that the true syndrome is a primary electrical disease performed particular ECG but a conduction disturbance at the right ventricular outflow tract (RVOT) related to clinical events (Martini and Nava, 2004; Marras et al, 2009). According to the expert consensus in 2013, patients with Brugada type 1 ECG induced by Class I antiarrhythmic drugs are included (Priori et al, 2013). Male gender has been consistently shown to be a risk factor for a greater number of arrhythmic events in patients with Brugada Syndrome (BrS). We conducted a pooled analysis on gender differences in prognosis and risk stratification of BrS with a largest sample capacity at present
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