Key result
Among patients with severely symptomatic Brugada syndrome, women were significantly less likely to have a spontaneous type-1 ECG at baseline compared to men (25% vs 72%, P=0.02).
Why the study?
Does the presence of spontaneous type-1 ECG pattern differ between women and men with severely symptomatic Brugada syndrome?
Observational (n=58)
Yes
Does the presence of spontaneous type-1 ECG pattern differ between women and men with severely symptomatic Brugada syndrome?
Absolute Event Rate: 25% vs 72%
p-value: p=0.02
Women with severely symptomatic Brugada syndrome are significantly less likely to present with a spontaneous type-1 ECG pattern compared to men, suggesting established risk factors derived from male-predominant populations may not reliably identify high-risk females.
Questions reliance on spontaneous type-1 ECG for risk stratification in women; leaves open need for sex-specific Brugada syndrome criteria.
UNLABELLED: Women with Brugada Syndrome. INTRODUCTION: Spontaneous type-1 ECG has been recognized as a risk factor for sudden cardiac death (SCD) in Brugada syndrome (BrS), but studied populations predominantly consisted of men. We sought to investigate whether a spontaneous type-1 ECG pattern was also associated in women with severely symptomatic BrS. Other known risk factors were also examined for gender specificity. METHODS: Patients with severely symptomatic BrS, defined as resuscitated SCD and/or appropriate implantable cardioverter-defibrillator (ICD) shock, were included from 11 European centers. Clinical data, investigation of family history, 12-lead ECG, and results of electrophysiological study (EPS) were collected. The average follow-up was 4 +/- 3 years. RESULTS: Fifty-eight patients fulfilled the inclusion criteria (mean age 47 +/- 11 years, 8 women). Thirty-six men (72%) but only two women (25%) had a spontaneous type-1 ECG at baseline (P = 0.02). Maximal ST elevation before or after drug challenge was 3.7 +/- 1.3 mm in men versus 2.4 +/- 0.7 mm in women (P = 0.007). The proportion of patients with a family history of SCD or an SCN5A mutation was not significantly different between both groups. Of those patients with high-risk BrS who underwent EPS, 76%(12/25) of men and 50%(2/4) of women had a positive study. CONCLUSION: In contrast to men, most women with BrS and resuscitated SCD or appropriate ICD shock do not have a spontaneous type-1 ECG pattern. In addition, the degree of ST elevation is less pronounced in women than men. While women represent a lower-risk group overall, risk factors established from a predominantly male population may not be helpful in identifying high-risk females.
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Sacher et al. (2008) conducted an observational in Severely symptomatic Brugada syndrome (n=58). Female sex vs. Male sex was evaluated on Spontaneous type-1 ECG at baseline (p=0.02). Among patients with severely symptomatic Brugada syndrome, women were significantly less likely to have a spontaneous type-1 ECG at baseline compared to men (25% vs 72%, P=0.02).
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