Abstract
Background and ObjectivesBrugada syndrome (BrS) is a cardiac ion channelopathy with characteristic electrocardiographic patterns, predisposing affected individuals to sudden cardiac death (SCD). Implantable cardioverter-defibrillator (ICD) is used for primary or secondary prevention in BrS, but its use remains controversial amongst low-risk asymptomatic patients. The present study aims to examine indicators for ICD implantation amongst BrS patients with different disease manifestations.MethodsThis study included BrS patients who received ICDs between 1997 and 2018. The cohort was divided into three categories based on presentations before ICD implantation: asymptomatic, syncope, ventricular tachycardia/ventricular fibrillation (VT/VF). Univariate and multivariate Cox-regression analysis were performed to identify independent predictors of appropriate and inappropriate shock delivery.ResultsA total of 136 consecutive patients were included with a median follow-up of 95 (IQR: 80) months. Appropriate shocks were delivered in 34 patients (25.0%) whereas inappropriate shocks were delivered in 24 patients (17.6%). Complications occurred in 30 patients (22.1%). Type 1 Brugada pattern were found to be an independent predictor of appropriate shock delivery, whilst the presence of other arrhythmia was predictive for both appropriate and inappropriate ICD shock delivery under multivariate Cox regression analysis.ConclusionICD therapy is effective for primary and secondary prevention of SCD in BrS. Whilst appropriate shocks occur more frequently in BrS patients presenting with VT/VF, they also occur in asymptomatic patients. Further research in risk stratification can improve patient prognosis while avoid unnecessary ICD implantation.
Highlights
Brugada syndrome (BrS) is a cardiac ion channelopathy with characteristic electrocardiographic Brugada patterns (BrP) in the right precordial leads (Antzelevitch et al, 2005)
The present study investigated the outcomes of BrS patients receiving implantable cardioverter-defibrillators (ICDs) for primary or secondary prevention of sudden cardiac death (SCD) to examine indicators for ICD implantation amongst BrS patients presented with ventricular tachy-arrhythmia, syncope or asymptomatic
ICD implantation in asymptomatic patients were performed based on VT/VF inducibility in electrophysiological studies (EPS) (n = 16), and a combination of positive drug challenge test and family history of SCD (n = 1) (Priori et al, 2013)
Summary
Brugada syndrome (BrS) is a cardiac ion channelopathy with characteristic electrocardiographic Brugada patterns (BrP) in the right precordial leads (Antzelevitch et al, 2005). Implantable cardioverter-defibrillators (ICDs) is the only definitive treatment with well-demonstrated efficacy in the management of SCD amongst BrS patients (Brugada et al, 2000). Whilst those who are symptomatic or manifest with spontaneous type 1 patterns are recognized to be at higher risks and should receive ICDs, whether asymptomatic patients should have device therapy remains controversial. Brugada syndrome (BrS) is a cardiac ion channelopathy with characteristic electrocardiographic patterns, predisposing affected individuals to sudden cardiac death (SCD). The present study aims to examine indicators for ICD implantation amongst BrS patients with different disease manifestations
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