Key result
ICD therapy in Brugada syndrome was associated with appropriate shocks in 18.1% and inappropriate shocks in 18.1% of patients over a mean follow-up of 82.3 months.
Why the study?
Although ICD implantation is recommended for Brugada syndrome to prevent sudden cardiac death, long-term outcomes and ICD complications remain controversial.
What are the long-term complication and shock rates of implantable cardioverter-defibrillators in patients with Brugada syndrome?
Systematic Review (n=747)
What are the long-term complication and shock rates of implantable cardioverter-defibrillators in patients with Brugada syndrome?
ICD therapy in Brugada syndrome carries a significant long-term burden of complications, notably an 18.1% rate of inappropriate shocks and various lead-related issues.
Equal appropriate and inappropriate ICD shock rates in Brugada syndrome warrant caution; leaves open optimal patient selection.
BACKGROUND: Brugada syndrome (BrS) is associated with sudden cardiac death (SCD). Although implantable cardioverter-defibrillator (ICD) implantation is recommended, the long-term outcomes and follow-up data with regard to ICD complications have led to controversy. HYPOTHESIS: In the present study, we described the data assimilated in a total of 11 studies, analyzing the outcome in 747 BrS patients receiving ICD. METHODS: Data were performed and analyzed after a systematic review of literature compiled from a thorough database search (PubMed, Web of Science, Cochrane Library, and Cinahl). RESULTS: The mean age of patients receiving ICD was (43.1 ± 13.4, 82.5% males, 46.6% spontaneous BrS type I). Around 15.3% of the patients were admitted due to SCD and 10.4% suffered from atrial arrhythmia. Appropriate shocks were documented in 18.1% of the patients over a mean follow-up period of 82.3 months (47.5-110.4). The following complications were recorded: lead failure and fracture (5.4%), lead perforation (0.7%), lead dislodgement (1.7%), infection (3.9%), pain (0.4%), subclavian vein thrombosis (0.3%), pericardial effusion (0.1%), endocarditis (0.1%), psychiatric problems (1.5%), pneumothorax (0.7%). Inappropriate shocks were documented in 18.1% of the patients. The management of inappropriate shocks was achieved by pulmonary vein isolation (0.5%), drug treatment with sotalol (1.3%) or sotalol with beta-blocker (0.3%) and hydroquinidine (0.1%). CONCLUSIONS: ICD therapy in BrS is associated with relevant ICD-related complications including a substantial risk of inappropriate shocks more frequently in symptomatic BrS patients.
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El‐Battrawy et al. (2019) conducted a systematic review in Brugada syndrome (n=747). Implantable cardioverter-defibrillator (ICD) was evaluated on Appropriate shocks. ICD therapy in Brugada syndrome was associated with appropriate shocks in 18.1% and inappropriate shocks in 18.1% of patients over a mean follow-up of 82.3 months.
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