Risk stratification in patients with Brugada syndrome without previous cardiac arrest – prognostic value of combined risk factors.

Abstract

BACKGROUND:

Risk stratification in patients with Brugada syndrome for primary prevention of sudden cardiac death is still an unsettled issue. A recent consensus statement suggested the indication of implantable cardioverter defibrillator (ICD) depending on the clinical risk factors present (spontaneous type 1 Brugada electrocardiogram (ECG) [Sp1], history of syncope [syncope], and ventricular fibrillation during programmed electrical stimulation [PES+]). The indication of ICD for the majority of patients, however, remains unclear.

METHODS AND RESULTS:

A total of 218 consecutive patients (211 male; aged 46 ± 13 years) with a type 1 Brugada ECG without a history of cardiac arrest who underwent evaluation for ICD including electrophysiological testing were examined retrospectively. During a mean follow-up period of 78 months, 26 patients (12%) developed arrhythmic events. On Kaplan-Meier analysis patients with each of Sp1, syncope, or PES+ suffered arrhythmic events more frequently (P=0.018, P<0.001, and P=0.003, respectively). On multivariate analysis Sp1 and syncope were independent predictors of arrhythmic events. When dividing patients according to the number of these 3 risk factors present, patients with 2 or 3 risk factors experienced arrhythmic events more frequently than those with 0 or 1 risk factor (23/93 vs. 3/125; P<0.001).

CONCLUSIONS:

Syncope, Sp1, and PES+ are important risk factors and the combination of these risks well stratify the risk of later arrhythmic events.

• Authors: Hideo Okamura, Tsukasa Kamakura, Hiroshi Morita, Koji Tokioka, Ikutaro Nakajima, Mitsuru Wada, Kohei Ishibashi, Koji Miyamoto, Takashi Noda, Takeshi Aiba, Nobuhiro Nishii, Satoshi Nagase, Wataru Shimizu, Satoshi Yasuda, Hisao Ogawa, Shiro Kamakura, Hiroshi Ito, Tohru Ohe, Kengo F Kusano
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 79 Issue 2 Pg. 310-7 ( 2015) ISSN: 1347-4820 [Electronic] Japan
• PMID: 25428522 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Brugada Syndrome (complications, diagnosis, epidemiology, physiopathology)
• Electrocardiography
• Female
• Follow-Up Studies
• Heart Arrest
• Humans
• Male
• Middle Aged
• Prognosis
• Risk Assessment
• Risk Factors
• Syncope (diagnosis, epidemiology, etiology, physiopathology)
• Ventricular Fibrillation (diagnosis, epidemiology, etiology, physiopathology)