Key result
ICD therapy treats lethal arrhythmias in ~17% of Brugada patients despite frequent inappropriate shocks.
Why the study?
Device-based management of asymptomatic patients with Brugada syndrome is controversial, and ICD therapy is associated with high rates of inappropriate shocks and device-related complications.
Cohort (n=176)
No
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“ICD therapy is related to a non-negligible rate of device-related issues highly affecting young patients' quality of life”
“In this issue of the JACC, Conte and colleagues from the Brugada group in Belgium report their 20-year, single-center experience”
Clinical evaluation demonstrates high efficacy of implantable cardioverter-defibrillators in Brugada syndrome, highlighting the necessity of managing device-related complications.
BACKGROUND: Patients with Brugada syndrome and aborted sudden cardiac death or syncope have higher risks for ventricular arrhythmias (VAs) and should undergo implantable cardioverter-defibrillator (ICD) placement. Device-based management of asymptomatic patients is controversial. ICD therapy is associated with high rates of inappropriate shocks and device-related complications. OBJECTIVES: The objective of this study was to investigate clinical features, management, and long-term follow-up of ICD therapy in patients with Brugada syndrome. METHODS: Patients presenting with spontaneous or drug-induced Brugada type 1 electrocardiographic findings, who underwent ICD implantation and continuous follow-up at a single institution, were eligible for this study. RESULTS: A total of 176 consecutive patients were included. During a mean follow-up period of 83.8 ± 57.3 months, spontaneous sustained VAs occurred in 30 patients (17%). Eight patients (4.5%) died. Appropriate ICD shocks occurred in 28 patients (15.9%), and 33 patients (18.7%) had inappropriate shocks. Electrical storm occurred in 4 subjects (2.3%). Twenty-eight patients (15.9%) experienced device-related complications. In multivariate Cox regression analysis, aborted sudden cardiac death and VA inducibility on electrophysiologic studies were independent predictors of appropriate shock occurrence. CONCLUSIONS: ICD therapy was an effective strategy in Brugada syndrome, treating potentially lethal arrhythmias in 17% of patients during long-term follow-up. Appropriate shocks were significantly associated with the presence of aborted sudden cardiac death but also occurred in 13% of asymptomatic patients. Risk stratification by electrophysiologic study may identify asymptomatic patients at risk for arrhythmic events and could be helpful in investigating syncope not related to VAs. ICD placement is frequently associated with device-related complications, and rates of inappropriate shocks remain high regardless of careful device programming.
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Conte et al. (2015) conducted a cohort in Brugada syndrome (n=176). Implantable Cardioverter-Defibrillator (ICD) therapy was evaluated on Spontaneous sustained ventricular arrhythmias. In patients with Brugada syndrome, ICD therapy treated potentially lethal arrhythmias in 17% over a mean follow-up of 83.8 months, though 18.7% experienced inappropriate shocks.
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