Key result
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.
Why the study?
Do specific clinical and electrocardiographic factors predict sudden cardiac death, syncope, or internal defibrillator shock 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.
Supports refined ICD decisions via risk stratification in Brugada syndrome; confirms key predictors from pooled data.
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.
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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.
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