ICDs in Brugada Syndrome Patients
What are the long-term outcomes after implantable cardioverter-defibrillator (ICD) placement in Brugada syndrome patients?
In this registry, there were 370 patients with Brugada syndrome. The follow-up was 43 ± 14 years, and 74% were male. A total of 104 patients (28.1%) were treated with ICDs. The authors analyzed the long-term incidence of shocks and complications in patients who underwent ICD implantation.
An ICD was implanted for secondary prevention in 10 patients (10%), and for primary prevention in 94 patients (90%). After a mean follow-up of 9 years, 21 patients (20%) experienced a total of 81 appropriate shocks (incidence rate 2.2% person-year). The rate of appropriate shock was higher in secondary prevention patients (p < 0.01). However, 4 of the 45 asymptomatic patients (8.9%) experienced appropriate ICD therapy, all with a spontaneous type 1 electrocardiogram (ECG) and inducible ventricular arrhythmias. In the multivariable analysis, type 1 ECG with syncope (hazard ratio [HR], 4.96; 95% confidence interval [CI], 1.87-13.14; p < 0.01) and secondary prevention indication (HR, 6.85; 95% CI, 2.29-20.50; p < 0.01) were significant predictors of appropriate therapy. Nine patients (8.7%) suffered 37 inappropriate shocks (incidence rate 0.9% person-year). Twenty-one patients (20%) had other ICD-related complications (incidence rate 1.4% person-year). Three patients (2.9%) died (one electrical storm and two noncardiovascular deaths).
ICD therapy is an effective therapy in high-risk patients with Brugada syndrome, but it is associated with a significant risk of device-related complications.
Rate of appropriate therapy in Brugada syndrome varies widely across reports, and the indications for ICD implantation for primary prevention in Brugada syndrome remain debatable due to lack of a satisfying risk stratification scheme. Appropriate ICD therapies in this study were significantly associated with the presence of aborted sudden death and syncope with the presence of type 1 ECG pattern. However, appropriate shocks also occurred in 9% of asymptomatic patients in which ventricular arrhythmias were induced on electrophysiology study. The risk of ICD-related adverse events was high at 23%. In addition to improved risk stratification for sudden death, emphasis should be placed on programming to reduce inappropriate shocks.
Keywords: Arrhythmias, Cardiac, Brugada Syndrome, Cardiac Electrophysiology, Death, Sudden, Defibrillators, Implantable, Electrocardiography, Primary Prevention, Secondary Prevention, Syncope
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