Key result
Implantable cardioverter-defibrillators in Brugada syndrome patients delivered appropriate therapy in 12% of patients over 77 months, but inappropriate shocks occurred in 24%.
Cohort (n=378)
Yes
ICDs provide appropriate therapy in Brugada syndrome patients, including asymptomatic individuals (1%/year), but are associated with high rates of lead failure and inappropriate shocks which can be mitigated by optimal programming.
Appropriate ICD therapy in Brugada syndrome is offset by frequent inappropriate shocks; leaves open refined selection and programming strategies.
BACKGROUND: Implantable cardioverter-defibrillator indications in Brugada syndrome remain controversial, especially in asymptomatic patients. Previous outcome data are limited by relatively small numbers of patients or short follow-up durations. We report the outcome of patients with Brugada syndrome implanted with an implantable cardioverter-defibrillator in a large multicenter registry. METHODS AND RESULTS: A total of 378 patients (310 male; age, 46±13 years) with a type 1 Brugada ECG pattern implanted with an implantable cardioverter-defibrillator (31 for aborted sudden cardiac arrest, 181 for syncope, and 166 asymptomatic) were included. Fifteen patients (4%) were lost to follow-up. During a mean follow-up of 77±42 months, 7 patients (2%) died (1 as a result of an inappropriate shock), and 46 patients (12%) had appropriate device therapy (5±5 shocks per patient). Appropriate device therapy rates at 10 years were 48% for patients whose implantable cardioverter-defibrillator indication was aborted sudden cardiac arrest, 19% for those whose indication was syncope, and 12% for the patients who were asymptomatic at implantation. At 10 years, rates of inappropriate shock and lead failure were 37% and 29%, respectively. Inappropriate shock occurred in 91 patients (24%; 4±4 shocks per patient) because of lead failure (n=38), supraventricular tachycardia (n=20), T-wave oversensing (n=14), or sinus tachycardia (n=12). Importantly, introduction of remote monitoring, programming a high single ventricular fibrillation zone (>210-220 bpm), and a long detection time were associated with a reduced risk of inappropriate shock. CONCLUSIONS: Appropriate therapies are more prevalent in symptomatic Brugada syndrome patients but are not insignificant in asymptomatic patients (1%/y). Optimal implantable cardioverter-defibrillator programming and follow-up dramatically reduce inappropriate shock. However, lead failure remains a major problem in this population.
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Sacher et al. (2013) conducted a cohort in Brugada syndrome (n=378). Implantable cardioverter-defibrillator was evaluated on Appropriate device therapy. Implantable cardioverter-defibrillators in Brugada syndrome patients delivered appropriate therapy in 12% of patients over 77 months, but inappropriate shocks occurred in 24%.
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