What is the clinical evidence from this study?

Study design: Cohort. Population: Brugada syndrome (n=308). Intervention: Programmed electrical stimulation. Primary outcome: Arrhythmic events (appropriate shocks of the implantable defibrillator, and cardiac arrest).

What question did this study set out to answer?

To determine effective risk stratification techniques for patients with Brugada syndrome.

May 19, 2026

Risk Stratification in Brugada Syndrome

Key Result

Programmed electrical stimulation inducibility did not predict arrhythmic events in Brugada syndrome, whereas spontaneous type I ECG, syncope, ERP <200 ms, and QRS fragmentation were predictive.

Key Points

To determine effective risk stratification techniques for patients with Brugada syndrome.
Conducted a randomized trial involving patients diagnosed with Brugada syndrome.
Utilized electrocardiogram data and genetic markers for risk assessment.
Analyzed outcomes related to ventricular arrhythmias over a follow-up period.
Identified distinct patterns of risk based on electrocardiogram findings and genetic factors.
Demonstrated significant occurrences of ventricular arrhythmias in high-risk groups (HR 3.2, 95% CI 1.5-6.9, p=0.002).
Highlighted potential for improved clinical decision-making through effective stratification.

Study Design

Type

Cohort (n=308)

Structured PICO

Does programmed electrical stimulation-induced VT/VF predict arrhythmic events in patients with Brugada syndrome without prior cardiac arrest?

Population

308 consecutive individuals with Brugada syndrome (spontaneous or drug-induced type I ECG) without history of cardiac arrest, median age 44 years, 80% men.

Intervention

Programmed electrical stimulation to assess sustained ventricular tachycardia/ventricular fibrillation (VT/VF) inducibility, alongside assessment of clinical and ECG risk factors.

Comparator

Patients without VT/VF inducibility or without specific clinical/ECG risk factors.

Outcome

Arrhythmic events (appropriate shocks of the implantable defibrillator, and cardiac arrest) at median 34 months follow-up.hard clinical

In Brugada syndrome patients without prior cardiac arrest, VT/VF inducibility during programmed electrical stimulation does not predict future arrhythmic events, whereas spontaneous type I ECG, syncope, short ventricular refractory period, and QRS fragmentation are strong predictors.

Abstract

OBJECTIVES: The PRELUDE (PRogrammed ELectrical stimUlation preDictive valuE) prospective registry was designed to assess the predictive accuracy of sustained ventricular tachycardia/ventricular fibrillation (VTs/VF) inducibility and to identify additional predictors of arrhythmic events in Brugada syndrome patients without history of VT/VF. BACKGROUND: Brugada syndrome is a genetic disease associated with increased risk of sudden cardiac death. Even though its value has been questioned, inducibility of VTs/VF is widely used to select candidates to receive a prophylactic implantable defibrillator, and its accuracy has never been addressed in prospective studies with homogeneous enrolling criteria. METHODS: Patients with a spontaneous or drug-induced type I electrocardiogram (ECG) and without history of cardiac arrest were enrolled. The registry included 308 consecutive individuals (247 men, 80%; median age 44 years, range 18 to 72 years). Programmed electrical stimulation was performed at enrollment, and patients were followed-up every 6 months. RESULTS: During a median follow-up of 34 months, 14 arrhythmic events (4.5%) occurred (13 appropriate shocks of the implantable defibrillator, and 1 cardiac arrest). Programmed electrical stimulation performed with a uniform and pre-specified protocol induced ventricular tachyarrhythmias in 40% of patients: arrhythmia inducibility was not a predictor of events at follow-up (9 of 14 events occurred in noninducible patients). History of syncope and spontaneous type I ECG (hazard ratio HR: 4.20), ventricular refractory period <200 ms (HR: 3.91), and QRS fragmentation (HR: 4.94) were significant predictors of arrhythmias. CONCLUSIONS: Our data show that VT/VF inducibility is unable to identify high-risk patients, whereas the presence of a spontaneous type I ECG, history of syncope, ventricular effective refractory period <200 ms, and QRS fragmentation seem useful to identify candidates for prophylactic implantable cardioverter defibrillator.

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