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Long-term prognosis of patients with Brugada syndrome and an implanted cardioverter-defibrillator.

AbstractINTRODUCTION:
Risk stratification of Brugada syndrome (BrS) remains controversial and recommendations for an implantable cardioverter-defibrillator (ICD) are not well established. The objective of this study was to assess the long-term prognosis of BrS patients with an ICD.
METHODS AND RESULTS:
Of 55 consecutive patients with BrS assessed between April 2002 and October 2012, 36 (mean age 41.7 ± 13.8 years; 81.8% male) underwent ICD implantation. Nineteen (52.8%) were asymptomatic, 11 (30.6%) had previous history of syncope (arrhythmic cause suspected in eight) and six (16.7%) had aborted sudden cardiac death (SCD). Spontaneous type 1 electrocardiographic (ECG) pattern was present in 25 (69.4%) patients and electrophysiological study (EPS), performed in 26 (72.2%), was positive in 22 (84.6%). During a mean follow-up of 74 ± 40 months (>5 years in 72% of cases), seven (19.4%) patients had appropriate shocks (annual event rate 2.8%). These patients most frequently had aborted SCD (54.1% vs. 6.9%; p=0.008) and nonsustained ventricular tachycardia (57.1% vs. 10.3%; p=0.016) during follow-up. Spontaneous type 1 ECG pattern, syncope and positive EPS were not significantly associated with appropriate shocks. Multivariate analysis revealed that aborted SCD was an independent predictor of appropriate shocks (HR 8.07, 95% CI 1.58-41.2; p=0.012). ROC curve analysis demonstrated that aborted SCD had moderate discriminatory power to predict appropriate shocks (AUC 0.751), with sensitivity of 57% and specificity of 93%. In terms of ICD-related complications, eight (22.2%) patients had inappropriate shocks during the follow-up period, mainly due to sinus tachycardia (five patients); one patient had lead infection and another had a lead fracture.
CONCLUSION:
In this population of BrS patients with ICD, the long-term rate of appropriate shocks was 2.8%/year. Aborted SCD was associated with a higher risk of appropriate shocks, whereas syncope and spontaneous type I ECG pattern did not predict this event.
AuthorsHélder Dores, Katya Reis Santos, Pedro Adragão, Francisco Moscoso Costa, Pedro Galvão Santos, Pedro Carmo, Diogo Cavaco, Francisco Bello Morgado, Miguel Mendes
JournalRevista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology (Rev Port Cardiol) Vol. 34 Issue 6 Pg. 395-402 (Jun 2015) ISSN: 2174-2030 [Electronic] Portugal
PMID26028488 (Publication Type: Journal Article)
CopyrightCopyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.
Topics
  • Adult
  • Brugada Syndrome (complications, therapy)
  • Death, Sudden, Cardiac (etiology, prevention & control)
  • Defibrillators, Implantable
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Retrospective Studies
  • Time Factors
  • Young Adult

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