Key result
Risk stratification for asymptomatic Brugada syndrome requires a multifactorial approach over single clinical markers.
Why the study?
Current prognostic risk stratification of asymptomatic patients with Brugada syndrome is suboptimal, and no single marker alone can guide defibrillator implantation.
How can asymptomatic patients with Brugada syndrome be optimally risk-stratified for sudden death to guide implantable defibrillator therapy?
How can asymptomatic patients with Brugada syndrome be optimally risk-stratified for sudden death to guide implantable defibrillator therapy?
Current risk stratification for asymptomatic Brugada syndrome is suboptimal, necessitating multiparametric approaches and potentially future imaging techniques like MRI to guide ICD implantation.
May warrant multiparametric evaluation before ICD decisions in asymptomatic Brugada syndrome; leaves open prospective validation of refined models.
The current prognostic stratification of asymptomatic patients with Brugada syndrome is suboptimal. The so-called 'Brugada burden' concept is certainly emerging: the more extensive are the electrocardiographic alterations of the syndrome in space (peripheral as well as precordial derivations) and in time (persistence in the follow-up of electrocardiographic alterations), the greater the probability of arrhythmic events. Numerous clinical and electrocardiographic markers have been considered risk factors, but none of them alone is able to guide the choice of whether or not to implant a defibrillator, the only therapy so far proved effective in preventing SD (sudden death) in these patients. The prognostic value of the electrophysiology study also gradually decreased over time. Therapeutic decisions must therefore be taken, at the moment, considering a large number of variables, possibly included in risk scores to be validated prospectively and in large series. Magnetic resonance and the study of electro-anatomical alterations of the right ventricular outflow tract will most likely improve our prognostic stratification capacity in the future.
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Stazi et al. (2022) conducted a review in Brugada syndrome. Prognostic stratification of asymptomatic Brugada syndrome remains suboptimal, requiring a multifactorial approach rather than relying on single clinical or electrocardiographic markers.
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