Implantable Loop Recorders in patients with Brugada Syndrome: the BruLoop Study

Abstract

Abstract Aims Available data on continuous rhythm monitoring by implantable loop recorders (ILRs) in patients with Brugada syndrome (BrS) are scarce. Aim of this multicentre study was to evaluate the diagnostic yield and clinical implication of a continuous rhythm monitoring strategy by ILRs in a large cohort of BrS patients, and to assess the precise arrhythmic cause of syncopal episodes. Methods and Results A total of 370 patients with BrS and ILRs (mean age 43.5±15.9, 33.8% females) from 18 international centers were included. Overall, 274 (74.1%) were implanted due to symptoms (69.3% syncope, 30.7% palpitations). Over a median follow-up of 3 years, an arrhythmic event was recorded in 30.7% of symptomatic patients (18.6% atrial arrhythmias (AAs); 10.2% bradyarrhythmias (BAs) and 7.3% ventricular arrhythmias (VAs)). In patients with recurrent syncope, the etiology was arrhythmic in 22.4% (59.3% BAs, 25.0% VAs and 15.6% AAs). The ILR led to drug therapy initiation in 11.4%, ablation procedure in 10.9%, implantation of PM in 2.5% and ICD in 8%. At multivariate analysis, the presence of symptoms (HR 2.5, p=0.001) and age >50 years (HR 1.7, p=0.016) were independent predictors of arrhythmic events, while inducibility of VF at EP study (HR 9.0, p<0.001) was predictor of ventricular arrhythmias. Conclusion ILR detects arrhythmic events in nearly 30% of symptomatic BrS patients, leading to an appropriate therapy in 70% of them. The most commonly detected arrhythmias are AAs and BAs, while VAs are detected only in 7% of cases. Symptom status can be used to guide ILR implantation.General ResultsArrhythmias