Key result
Symptomatic drug-induced and asymptomatic spontaneous Type-1 Brugada patterns carry similar major arrhythmic event risk.
Why the study?
Risk stratification in Brugada syndrome is challenging because major arrhythmic events are rare, motivating an assessment of the utility of drug challenge testing.
Does drug challenge testing predict major arrhythmic events in patients with Brugada syndrome?
Systematic Review (n=4,099)
Does drug challenge testing predict major arrhythmic events in patients with Brugada syndrome?
Ventricular tachyarrhythmia during drug challenge testing is a useful risk marker for major arrhythmic events in Brugada syndrome, and symptomatic drug challenge-induced Type-1 carries a similar risk to asymptomatic spontaneous Type-1.
Supports ICD consideration for symptomatic drug-induced Brugada; extends risk stratification evidence from pooled observational data.
Introduction: Brugada syndrome is associated with ventricular arrhythmia leading to sudden cardiac death. Risk stratification is challenging, as major arrhythmic events (MAE) are rare. We assessed the utility of drug challenge testing in Brugada syndrome 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. Data were combined using the random-effects, generic inverse variance method, to calculate pooled incidence and odds ratio (OR). Mixed-effects Poisson regression was used to calculated incidence rate ratio (IRR). Eighteen studies from 2006 to 2018 were included (4,099 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: -0.3-4.4), and 19.6 (95% CI: 9.9-29.3) per 1,000 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). The presence of ventricular tachyarrhythmia during drug challenge testing was a predictor of MAE (OR=3.73, 95% CI: 1.77-7.86, p=0.001). 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. Ventricular tachyarrhythmia during drug challenge testing could be a useful risk marker for MAE in Brugada syndrome.
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Rattanawong et al. (2020) conducted a systematic review in Brugada syndrome (n=4,099). Drug challenge testing vs. Spontaneous Type-1 Brugada syndrome was evaluated on Major arrhythmic events (MAE) (IRR 1.0, 95% CI 0.6-1.7). In Brugada syndrome, the incidence of major arrhythmic events was similar between symptomatic drug challenge-induced and asymptomatic spontaneous Type-1 (IRR 1.0; 95% CI 0.6-1.7).
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