A spontaneous Type I Brugada ECG (RR 4.65), history of syncope or sudden cardiac death (RR 3.24), and male sex (RR 3.47) significantly predicted adverse events in patients with a Brugada ECG.
Meta-Analysis (n=1,545)
Do specific clinical and electrocardiographic factors predict sudden cardiac death, syncope, or internal defibrillator shock in patients with a Brugada ECG?
A history of syncope or SCD, spontaneous Type I Brugada ECG, and male gender are significant predictors of adverse events in patients with a Brugada ECG, while EPS inducibility, family history of SCD, and SCN5A mutations are not.
Effect estimate: RR 4.65 (95% CI 2.25-9.58)
p-value: p=<0.001
OBJECTIVES: We performed a meta-analysis of prognostic studies of patients with a Brugada ECG to assess predictors of events. BACKGROUND: The Brugada syndrome is an increasingly recognized cause of idiopathic ventricular fibrillation; however, there is wide variation in the prognosis of patients with the Brugada ECG. METHODS AND RESULTS: We retrieved 30 prospective studies of patients with the Brugada ECG, accumulating data on 1,545 patients. Summary estimates of the relative risk (RR) of events (sudden cardiac death SCD, syncope, or internal defibrillator shock) for a variety of potential predictors were made using a random-effects model. The overall event rate at an average of 32 months follow-up was 10.0% (95% CI 8.5%, 11.5%). The RR of an event was increased (P < 0.001) among patients with a history of syncope or SCD (RR 3.24 95% CI 2.13, 4.93), men compared with women (RR 3.47 95% CI 1.58, 7.63), and patients with a spontaneous compared with sodium-channel blocker induced Type I Brugada ECG (RR 4.65 95% CI 2.25, 9.58). The RR of events was not significantly increased in patients with a family history of SCD (P = 0.97) or a mutation of the SCN5A gene (P = 0.18). The RR of events was also not significantly increased in patients inducible compared with noninducible by electrophysiologic study (EPS) (RR 1.88 95% CI 0.62, 5.73, P = 0.27); however, there was significant heterogeneity of the studies included. CONCLUSIONS: Our findings suggest that a history of syncope or SCD, the presence of a spontaneous Type I Brugada ECG, and male gender predict a more malignant natural history. Our findings do not support the use of a family history of SCD, the presence of an SCN5A gene mutation, or EPS to guide the management of patients with a Brugada ECG.
Gehi et al. (2006) conducted a meta-analysis in Brugada ECG (n=1,545). Spontaneous Type I Brugada ECG, history of syncope/SCD, and male gender vs. Induced Type I Brugada ECG, no history of syncope/SCD, and female gender was evaluated on Events (sudden cardiac death, syncope, or internal defibrillator shock) (RR 4.65, 95% CI 2.25-9.58, p=<0.001). A spontaneous Type I Brugada ECG (RR 4.65), history of syncope or sudden cardiac death (RR 3.24), and male sex (RR 3.47) significantly predicted adverse events in patients with a Brugada ECG.