Implantable cardioverter-defibrillator therapy in Brugada syndrome: a 20-year single-center experience

Patients with Brugada syndrome and aborted sudden cardiac death or syncope have higher risks for ventricular arrhythmias (VAs) and should undergo implantable cardioverter-defibrillator (ICD) placement. Device-based management of asymptomatic patients is controversial. ICD therapy is associated with...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2015-03, Vol.65 (9), p.879-888
Main Authors: Conte, Giulio, Sieira, Juan, Ciconte, Giuseppe, de Asmundis, Carlo, Chierchia, Gian-Battista, Baltogiannis, Giannis, Di Giovanni, Giacomo, La Meir, Mark, Wellens, Francis, Czapla, Jens, Wauters, Kristel, Levinstein, Moises, Saitoh, Yukio, Irfan, Ghazala, Julià, Justo, Pappaert, Gudrun, Brugada, Pedro
Format: Article
Language:English
Subjects:
Adolescent
Adrenergic beta-Antagonists - therapeutic use
Adult
Aged
Anti-Arrhythmia Agents - therapeutic use
Belgium - epidemiology
Brugada Syndrome - mortality
Brugada Syndrome - therapy
Child
Child, Preschool
Death, Sudden - prevention & control
Defibrillators, Implantable - adverse effects
Electrocardiography
Female
Follow-Up Studies
Humans
Male
Middle Aged
Multivariate Analysis
Sotalol - therapeutic use
Syncope - prevention & control
Tachycardia, Ventricular - prevention & control
Time Factors
Young Adult
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Summary:Patients with Brugada syndrome and aborted sudden cardiac death or syncope have higher risks for ventricular arrhythmias (VAs) and should undergo implantable cardioverter-defibrillator (ICD) placement. Device-based management of asymptomatic patients is controversial. ICD therapy is associated with high rates of inappropriate shocks and device-related complications. The objective of this study was to investigate clinical features, management, and long-term follow-up of ICD therapy in patients with Brugada syndrome. Patients presenting with spontaneous or drug-induced Brugada type 1 electrocardiographic findings, who underwent ICD implantation and continuous follow-up at a single institution, were eligible for this study. A total of 176 consecutive patients were included. During a mean follow-up period of 83.8 ± 57.3 months, spontaneous sustained VAs occurred in 30 patients (17%). Eight patients (4.5%) died. Appropriate ICD shocks occurred in 28 patients (15.9%), and 33 patients (18.7%) had inappropriate shocks. Electrical storm occurred in 4 subjects (2.3%). Twenty-eight patients (15.9%) experienced device-related complications. In multivariate Cox regression analysis, aborted sudden cardiac death and VA inducibility on electrophysiologic studies were independent predictors of appropriate shock occurrence. ICD therapy was an effective strategy in Brugada syndrome, treating potentially lethal arrhythmias in 17% of patients during long-term follow-up. Appropriate shocks were significantly associated with the presence of aborted sudden cardiac death but also occurred in 13% of asymptomatic patients. Risk stratification by electrophysiologic study may identify asymptomatic patients at risk for arrhythmic events and could be helpful in investigating syncope not related to VAs. ICD placement is frequently associated with device-related complications, and rates of inappropriate shocks remain high regardless of careful device programming.
ISSN:1558-3597
DOI:10.1016/j.jacc.2014.12.031