Key result
A history of syncope (HR 6.81) and spontaneous type 1 Brugada ECG (HR 4.51) independently predicted sudden cardiac death or ventricular fibrillation in patients with Brugada syndrome without previous cardiac arrest.
Why the study?
Does the presence of clinical risk factors (Sp1, syncope, PES+) predict arrhythmic events in patients with Brugada syndrome without previous cardiac arrest?
Cohort (n=218)
Yes
Does the presence of clinical risk factors (Sp1, syncope, PES+) predict arrhythmic events in patients with Brugada syndrome without previous cardiac arrest?
Effect estimate: HR 6.81 (95% CI 2.76-20.46)
Absolute Event Rate: 24.1% vs 3.8%
p-value: p=<0.001
The combination of spontaneous type 1 Brugada ECG, history of syncope, and ventricular fibrillation during programmed electrical stimulation effectively stratifies the risk of future arrhythmic events in Brugada syndrome patients without prior cardiac arrest.
May aid risk stratification in Brugada syndrome without arrest; leaves open whether these factors should guide ICD decisions.
BACKGROUND: Risk stratification in patients with Brugada syndrome for primary prevention of sudden cardiac death is still an unsettled issue. A recent consensus statement suggested the indication of implantable cardioverter defibrillator (ICD) depending on the clinical risk factors present (spontaneous type 1 Brugada electrocardiogram (ECG) [Sp1], history of syncope [syncope], and ventricular fibrillation during programmed electrical stimulation [PES+]). The indication of ICD for the majority of patients, however, remains unclear. METHODS AND RESULTS: A total of 218 consecutive patients (211 male; aged 46 ± 13 years) with a type 1 Brugada ECG without a history of cardiac arrest who underwent evaluation for ICD including electrophysiological testing were examined retrospectively. During a mean follow-up period of 78 months, 26 patients (12%) developed arrhythmic events. On Kaplan-Meier analysis patients with each of Sp1, syncope, or PES+ suffered arrhythmic events more frequently (P=0.018, P<0.001, and P=0.003, respectively). On multivariate analysis Sp1 and syncope were independent predictors of arrhythmic events. When dividing patients according to the number of these 3 risk factors present, patients with 2 or 3 risk factors experienced arrhythmic events more frequently than those with 0 or 1 risk factor (23/93 vs. 3/125; P<0.001). CONCLUSIONS: Syncope, Sp1, and PES+ are important risk factors and the combination of these risks well stratify the risk of later arrhythmic events.
No takes yet. Share an insight, caveat, or question.
Okamura et al. (2014) conducted a cohort in Brugada syndrome without previous cardiac arrest (n=218). History of syncope vs. No history of syncope was evaluated on Occurrence of ventricular fibrillation or sudden cardiac death (HR 6.81, 95% CI 2.76-20.46, p=<0.001). A history of syncope (HR 6.81) and spontaneous type 1 Brugada ECG (HR 4.51) independently predicted sudden cardiac death or ventricular fibrillation in patients with Brugada syndrome without previous cardiac arrest.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: