Key result
Brugada syndrome linked to ~266% higher S-ICD screening failure prevalence vs non-Brugada patients.
Why the study?
The prevalence of S-ICD ineligibility among conventional ICD recipients, especially comparing patients with and without Brugada syndrome, was unclear.
Does the presence of Brugada syndrome increase the rate of S-ICD screening failure in patients with conventional ICDs?
Cross-Sectional (n=130)
No
Does the presence of Brugada syndrome increase the rate of S-ICD screening failure in patients with conventional ICDs?
Patients with Brugada syndrome have a significantly higher rate of S-ICD screening failure, particularly those with low BMI, suggesting the need for careful screening and potential right parasternal electrode positioning.
Brugada syndrome was associated with higher S-ICD screening failure; hypothesis-generating and requires prospective validation before changing screening practice.
BACKGROUND: Subcutaneous implantable cardioverter-defibrillators (S-ICD) could eliminate lead-associated complications. We assessed the prevalence of S-ICD ineligibility in conventional ICD recipients and compared it in patients with and without Brugada syndrome (BrS). METHODS AND RESULTS: Consecutive patients with a transvenous ICD without an indication for antibradycardia pacing were assessed. A patient was considered eligible for S-ICD if the ECG satisfied the screening template, both supine and standing, in ≥1 lead. Among 130 patients (103 men, age 57±15 years), a total of 18 (13.8%) patients were ineligible. The BrS group (n=33) had a significantly higher prevalence of S-ICD screening failure as compared with the non-BrS group (P=0.003; 30% vs. 8.2%). In the BrS group, the body mass index (BMI) was significantly lower, and T/QRS amplitude in lead I was significantly higher in those who were ineligible than that in the patients who were eligible. Of the 10 BrS patients failing the screening, 4 became eligible in the right parasternal electrode position. CONCLUSIONS: Among current ICD patients, there was a high incidence of patients with BrS who were unsuitable for S-ICD based on the left parasternal screening test. Suitability screening of patients for S-ICDs should be conducted carefully in patients with BrS, particularly if the BMI is low. Right parasternal electrode positioning should also be tested in such BrS patients.
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Kawabata et al. (2017) conducted a cross-sectional in Brugada syndrome in conventional ICD recipients (n=130). Brugada syndrome vs. Non-Brugada syndrome was evaluated on S-ICD screening failure (ineligibility) (p=0.003). Brugada syndrome was associated with a significantly higher prevalence of subcutaneous implantable cardioverter-defibrillator screening failure compared to non-Brugada patients (30% vs. 8.2%, P=0.003).
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