In Brugada syndrome patients with a prophylactic ICD, the presence of an S-wave in lead I was an independent predictor of late life-threatening arrhythmic events after generator replacement (HR 9.17).
Cohort (n=105)
Yes
What are the predictors of late life-threatening arrhythmic events in Brugada syndrome patients undergoing prophylactic ICD generator replacement?
In Brugada syndrome patients without prior events, late appropriate ICD interventions occur in 9% after generator replacement, with an S-wave in lead I being an independent predictor of risk, supporting the need for continued ICD therapy.
Effect estimate: HR 9.17 (95% CI 1.15-73.07)
p-value: p=0.03
Introduction Predictors of late life-threatening arrhythmic events in Brugada syndrome (BrS) patients who received a prophylactic ICD implantation remain to be evaluated. The aim of the present long-term multicenter study was to assess the incidence and clinical-electrocardiographic predictors of late life-threatening arrhythmic events in BrS patients with a prophylactic implantable cardioverter defibrillator (ICD) and undergoing generator replacement (GR). Methods The study population included 105 patients (75% males; mean age 45 ± 14years) who received a prophylactic ICD and had no arrhythmic event up to first GR. Results The median period from first ICD implantation to last follow-up was 155 (128–181) months and from first ICD Implantation to the GR was 84 (61–102) months. During a median follow-up of 57 (38–102) months after GR, 10 patients (9%) received successful appropriate ICD intervention (1.6%/year). ICD interventions included shock on ventricular fibrillation ( n = 8 patients), shock on ventricular tachycardia ( n = 1 patient), and antitachycardia pacing on ventricular tachycardia ( n = 1 patient). At survival analysis, history of atrial fibrillation (log-rank test; P = 0.02), conduction disturbances (log-rank test; P 0.01), S wave in lead I (log-rank test; P = 0.01) and first-degree atrioventricular block (log-rank test; P = 0.04) were significantly associated with the occurrence of late appropriate ICD intervention. At Cox-regression multivariate analysis, S-wave in lead I was the only independent predictor of late appropriate ICD intervention (HR: 9.17; 95%CI: 1.15–73.07; P = 0.03). Conclusions The present study indicates that BrS patient receiving a prophylactic ICD may experience late appropriate intervention after GR in a clinically relevant proportion of cases. S-wave in lead I at the time of first clinical evaluation was the only independent predictor of persistent risk of life-threatening arrhythmic events. These findings support the need for GR at the end of service regardless of previous appropriate intervention, mostly in BrS patients with conduction abnormalities.
Migliore et al. (Fri,) conducted a cohort in Brugada syndrome (n=105). Prophylactic ICD generator replacement was evaluated on Late arrhythmic outcome (cardiac arrest/sudden cardiac death and appropriate ICD therapy after generator replacement) (HR 9.17, 95% CI 1.15-73.07, p=0.03). In Brugada syndrome patients with a prophylactic ICD, the presence of an S-wave in lead I was an independent predictor of late life-threatening arrhythmic events after generator replacement (HR 9.17).