Key result
A spontaneous Type 1 Brugada ECG pattern was associated with a significantly increased risk of arrhythmic events compared to non-Type 1 patterns (OR 2.88), with the risk being significant in males but not females.
Why the study?
Risk stratification combining spontaneous Type 1 Brugada ECG with other recognized risk factors, including gender, syncope, sudden cardiac arrest, and positive electrophysiological study, remains unclear.
Does a spontaneous Type-1 ECG pattern increase the risk of arrhythmic events in patients with Brugada syndrome compared to a non-Type 1 pattern?
Meta-Analysis (n=1,338)
Yes
Does a spontaneous Type-1 ECG pattern increase the risk of arrhythmic events in patients with Brugada syndrome compared to a non-Type 1 pattern?
Odds Ratio: 2.88 (95% CI 2.28–3.63)
p-value: p=<0.00001
A spontaneous Type-1 ECG pattern is an independent risk factor for sudden cardiac death in male patients with Brugada syndrome, and confers a worse prognosis when combined with a positive electrophysiological study.
May refine arrhythmic risk stratification in Brugada syndrome; leaves open prospective validation and sex-specific thresholds.
Aims: Risk stratification of patients with Brugada syndrome (BrS) is vital for accurate prognosis and therapeutic decisions. Spontaneous Type 1 ST segment elevation is generally considered to be an independent risk factor for arrhythmic events. Other risk factors include gender, syncope, sudden cardiac arrest (SCA) and positive electrophysiological study (EPS). However, the further risk stratification of of spontaneous type 1 combined with the other risk factors remains unclear. The present study pooled data from 4 large trials aiming to systematically evaluate the risk of spontaneous Type-1 ECG when combined with one or more of these other recognized risk factors. Methods: We searched for related studies published from November 2, 2002 to February 10, 2018 in PubMed, EMBASE, Cochrane Library, MEDLINE, Chinese National Knowledge Infrastructure (CNKI) and Wanfang Databases. The pooled data were evaluated combining each risk factor with the presence of a spontaneous Type-1 ECG. All analyses were performed using Review Manager, version 5.0.12. Results: Four eligible studies involving 1,338 patients (85% males, mean age: 48.1± 18.1 years) were enrolled. Spontaneous Type-1 ECG, was associated with higher risk for ventricular tachycardia/fibrillation (VT/VF) than cases with non-Type 1 ECG in males (odds ratio: 95% CI: 1.84–5.17; P<0.0001), but not in females (P=0.29). Among spontaneous Type-1 cases with syncope or with positive EPS, the difference was not statistically significant (P=0.06 and 0.07, respectively). Patients with Type-1 ECGs and positive EPS were at higher risk than those with negative EPS (95% CI: 1.10-5.04; P=0.03). Pooled analysis showed an association of Spontaneous Type-1 ECG, Type-1 ECGs combined with male, and Type-1 ECGs combined with positive EPS between increased risk of arrhythmic events. Conclusion: Our results indicate that in BrS patients, a spontaneous Type-1 ECG is an independent risk factor for SCD in males, but not in females. The less number of female patients remains the limitation of Brugada research. A spontaneous Type-1 BrS is associated with a worse prognosis when combined with positive EPS. This analysis is helpful for further clinical risk stratification of BrS.
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Li et al. (2019) conducted a meta-analysis in Brugada syndrome (n=1,338). Spontaneous Type 1 Brugada ECG pattern vs. Non-Type 1 Brugada ECG pattern was evaluated on Arrhythmic events (VT/VF or sudden cardiac death) (OR 2.88, 95% CI 2.28-3.63, p=<0.00001). A spontaneous Type 1 Brugada ECG pattern was associated with a significantly increased risk of arrhythmic events compared to non-Type 1 patterns (OR 2.88), with the risk being significant in males but not females.
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