Key result
Symptomatic drug-induced Type 1 Brugada syndrome shows similar major arrhythmic risk to asymptomatic spontaneous Type 1.
Why the study?
Risk stratification in Brugada syndrome is challenging because major arrhythmic events are rare, warranting assessment of the utility of drug challenge testing.
Does drug challenge-induced Type 1 Brugada pattern predict major arrhythmic events similarly to spontaneous Type 1 pattern in patients with Brugada syndrome?
Meta-Analysis (n=4,099)
Does drug challenge-induced Type 1 Brugada pattern predict major arrhythmic events similarly to spontaneous Type 1 pattern in patients with Brugada syndrome?
Effect estimate: IRR 1.0 (95% CI 0.6-1.7)
Drug challenge-induced Type 1 Brugada pattern in asymptomatic patients carries a low risk of major arrhythmic events, while symptomatic patients have a risk similar to asymptomatic spontaneous Type 1 patients.
Symptomatic drug-induced Type 1 Brugada patients warrant similar arrhythmic risk management as asymptomatic spontaneous Type 1; confirms symptoms as primary stratifier beyond induction method.
INTRODUCTION: Brugada syndrome (BrS) is associated with ventricular arrhythmia leading to sudden cardiac death. Risk stratification is challenging, as major arrhythmic events (MAEs) are rare. We assessed the utility of drug challenge testing in BrS by a systematic review and meta-analysis. METHODS AND RESULTS: We comprehensively searched the databases of MEDLINE and EMBASE from inception to May 2019. Included studies compared the incidence of MAE between spontaneous and drug challenge-induced Type 1. Mixed-effects Poisson regression was used to calculate the incidence rate ratio (IRR). Eighteen studies from 2006 to 2018 were included (4099 patients, mean follow-up: 4.5 years). Pooled annual incidences of MAE in spontaneous, drug challenge induced (regardless of symptoms), asymptomatic drug challenge induced, and symptomatic drug challenge-induced Type 1 were 23.8 (95% confidence interval [CI]: 19.8-27.8), 6.5 (95% CI: 3.9-9.1), 2.1 (95% CI: -0.3 to 4.4), and 19.6 (95% CI: 9.9-29.3) per 1000 person-years, respectively. The incidence of MAE between symptomatic drug challenge induced and asymptomatic spontaneous Type 1 was not statistically different (IRR = 1.0; 95% CI: 0.6-1.7). CONCLUSIONS: The incidence of MAE in drug challenge-induced Type 1 in asymptomatic patients is low. The incidence of MAE between symptomatic drug challenge induced and asymptomatic spontaneous Type 1 was similar.
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Rattanawong et al. (2020) conducted a meta-analysis in Brugada syndrome (n=4,099). Drug challenge testing vs. Spontaneous Type 1 was evaluated on Incidence of major arrhythmic events (IRR 1.0, 95% CI 0.6-1.7). Symptomatic drug challenge-induced Type 1 Brugada syndrome had a similar incidence of major arrhythmic events compared to asymptomatic spontaneous Type 1 (IRR 1.0; 95% CI 0.6-1.7).
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