Key result
A history of aborted cardiac arrest was a significant predictor of appropriate shocks (HR 11.34) and composite cardiac events (HR 4.78) in Brugada syndrome patients with an implantable cardioverter-defibrillator.
Cohort (n=69)
Yes
Hazard Ratio: 11.34 (95% CI 1.31–97.94)
Absolute Event Rate: 39.5% vs 7.1%
p-value: p=0.027
In Korean patients with Brugada syndrome, ICD implantation is associated with a 28% rate of appropriate shocks and 20% rate of inappropriate shocks over 5 years, with prior aborted cardiac arrest being the strongest predictor of future cardiac events.
Prior aborted cardiac arrest signals high shock risk in Brugada ICD patients; extends risk stratification but leaves prospective validation open.
PURPOSE: Our study aims to analyze prognosis after implantable cardioverter-defibrillator (ICD) implantation in Korean patients with Brugada syndrome (BrS). MATERIALS AND METHODS: This was a retrospective study of BrS patients implanted with an ICD at one of four centers in Korea between January 1998 and April 2012. Sixty-nine patients (68 males, 1 female) were implanted with an ICD based on aborted cardiac arrest (n=38, 55%), history of syncope (n=17, 25%), or induced ventricular tachyarrhythmia on electrophysiologic study in asymptomatic patients (n=14, 20%). A family history of sudden cardiac death and a spontaneous type 1 electrocardiography (ECG) were noted in 13 patients (19%) and 44 patients (64%), respectively. RESULTS: During a mean follow-up of 59±46 months, 4.6±5.5 appropriate shocks were delivered in 19 patients (28%). Fourteen patients (20%) experienced 5.2±8.0 inappropriate shocks caused by supraventricular arrhythmia, lead failure, or abnormal sensing. Six patients were admitted for cardiac causes during follow-up, but no cardiac deaths occurred. An episode of aborted cardiac arrest was a significant predictor of appropriate shock, and the composite of cardiac events in the Cox proportional hazard model [hazard ratio (95% confidence interval) was 11.34 (1.31-97.94) and 4.78 (1.41-16.22), respectively]. However, a spontaneous type 1 ECG was not a predictor of cardiac events. CONCLUSION: Appropriate shock (28%) and inappropriate shock (20%) were noted during a mean follow-up of 59±46 months in Korean BrS patients implanted with an ICD. An episode of aborted cardiac arrest was the most powerful predictor of cardiac events.
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Son et al. (2013) conducted a cohort in Brugada syndrome (n=69). Aborted cardiac arrest vs. Asymptomatic presentation was evaluated on Appropriate shock (HR 11.34, 95% CI 1.31-97.94, p=0.027). A history of aborted cardiac arrest was a significant predictor of appropriate shocks (HR 11.34) and composite cardiac events (HR 4.78) in Brugada syndrome patients with an implantable cardioverter-defibrillator.
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