Key result
In patients with Brugada syndrome and a negative electrophysiology study, an insertable cardiac monitor detected no ventricular arrhythmias but identified other arrhythmias in 19% of patients.
Why the study?
Implanting an ICM after a negative EPS in Brugada syndrome is common practice in some centers, but the diagnostic value of this strategy has never been specifically addressed.
Does insertable cardiac monitor implantation detect arrhythmias in Brugada syndrome patients with a negative electrophysiology study?
Cohort (n=26)
Yes
Does insertable cardiac monitor implantation detect arrhythmias in Brugada syndrome patients with a negative electrophysiology study?
A negative electrophysiology study in Brugada syndrome has a high negative predictive value for ventricular arrhythmias, and subsequent ICM implantation mainly detects incidental non-ventricular arrhythmias.
Suggests ICM may detect non-ventricular arrhythmias in Brugada syndrome with negative EPS; leaves open effects on risk stratification and need for trials.
Background/Introduction Risk stratification in Brugada syndrome (BrS) remains controversial. In this respect, the role of electrophysiology study (EPS) has been subject of debate. It is common practice in some centers to implant an insertable cardiac monitor (ICM) after a negative EPS, especially in the presence of unexplained symptoms. However, the diagnostic value of this approach has never been specifically addressed. Purpose We aimed to describe the baseline characteristics and the main findings of a diagnostic work-up strategy using an insertable cardiac monitor (ICM) after a negative EPS in patients with BrS. Methods We retrospectively evaluated data from a multicenter registry including 56 BrS patients from 7 referral hospitals who received an ICM to help risk stratification. Only patients with a negative EPS (ie, non-inducible VT/VF) prior to ICM implantation were considered for this analysis. EPS protocols differed across hospitals (see Figure 1) Results A total of 26 patients from 5 different hospitals were studied. Mean age was 33.0±12.8 and 77% were male. Spontaneous type 1 pattern was present in 12 patients (46%). Positive genotype was found in 10 (38%) and family history of sudden cardiac death was present in 11 (42%). Previous symptoms were syncope/presyncope in 15 patients (58%) and palpitations in 3 patients (12%). The rest of the patients (30%) were asymptomatic. After a median follow-up of 33.4 months (IQR 16.5 and 43.1 months), none of the patients presented ventricular arrhythmias. ICM allowed the detection of other arrhythmias in 5 patients (19%), which led to specific therapeutic actions in all but 2 of them (see Table 1). ICM-detected arrhythmias correlated with previously reported symptoms only in one of the patients. Conclusion The results of this exploratory analysis support the notion that EPS in BrS has a high negative predictive value for risk stratification. ICM implantation after a negative EPS may allow the detection of incidental arrhythmias during follow-up. Despite the apparent low correlation of these findings with previously reported symptoms, this strategy may lead to important treatment decisions in a significant proportion of patients.
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Jaén et al. (2022) conducted a cohort in Brugada syndrome (n=26). Insertable cardiac monitor after negative electrophysiology study was evaluated on Ventricular arrhythmias. In patients with Brugada syndrome and a negative electrophysiology study, an insertable cardiac monitor detected no ventricular arrhythmias but identified other arrhythmias in 19% of patients.
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