Key result
In patients with Brugada syndrome presenting with syncope, the risk of appropriate ICD shocks was similar between those with a spontaneous coved-type ECG (15.4%) and those unmasked by AAD test (9.3%).
Why the study?
Does a Class-I AAD test identify Brugada syndrome patients presenting with syncope who are at similar risk of ventricular arrhythmias compared to those with spontaneous coved-type ECG?
Cohort (n=58)
Does a Class-I AAD test identify Brugada syndrome patients presenting with syncope who are at similar risk of ventricular arrhythmias compared to those with spontaneous coved-type ECG?
Patients with Brugada syndrome presenting with syncope have a similar risk of ventricular arrhythmias whether their diagnostic ECG pattern is spontaneous or unmasked by a Class-I antiarrhythmic drug test.
Supports equivalent ICD decisions for Brugada syncope regardless of spontaneous or drug-unmasked ECG; leaves open need for prospective validation.
INTRODUCTION: The Brugada syndrome (BrS) can first present with syncope. Class-I antiarrhythmic drug (AAD) test is used to unmask the diagnostic coved-type ECG pattern in case it is not spontaneously present. The aim of the study was to analyze patients with BrS presenting with syncope as first manifestation and compare patients with syncope and a spontaneous coved-type ECG to patients with syncope in whom a class-I AAD test unmasked the disease. METHODS AND RESULTS: Fifty-eight of 157 probands (36.9%) had syncope as first manifestation of the disease. Twenty-six patients (44.8%, group A) showed a spontaneous coved-type ECG diagnostic for BrS at first presentation. In 32 patients (55.2%, group B) without spontaneous coved-type ECG pattern at first presentation (36% normal ECGs and 19% type-II ECG pattern), a class-I AAD test unmasked the disease. Twenty-one patients of group A and 29 patients of group B underwent implantable cardioverter defibrillator (ICD) implantation. The mean follow up as 9.7 ± 55.7 month. Four patients in group A (15.4%) and 3 patients (9.3%) in group B had appropriate ICD shock delivery due to ventricular fibrillation or ventricular tachycardia (P = NS). CONCLUSION: One of 3 patients with BrS presents first with syncope. More than one-third of these patients have a normal ECG at investigation for syncope and the correct diagnosis would have been missed without a class-I AAD test. Patients presenting with syncope are at similar risk irrespective of the presence of a spontaneous coved-type ECG.
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Roos et al. (2011) conducted a cohort in Brugada syndrome (n=58). Spontaneous coved-type ECG vs. Class-I AAD test unmasked coved-type ECG was evaluated on Appropriate ICD shock delivery due to ventricular fibrillation or ventricular tachycardia (p=NS). In patients with Brugada syndrome presenting with syncope, the risk of appropriate ICD shocks was similar between those with a spontaneous coved-type ECG (15.4%) and those unmasked by AAD test (9.3%).
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