What is the clinical evidence from this study?

Study design: Cohort. Population: Brugada Syndrome (n=136). Intervention: Type 1 Brugada pattern vs. Non-Type 1 Brugada pattern. Primary outcome: Appropriate ICD shock delivery (HR 2.07, 95% CI 1.05-4.06, p=0.035).

March 10, 2020Open Access

Outcomes in Brugada Syndrome Patients With Implantable Cardioverter-Defibrillators: Insights From the SGLT2 Registry

Key Result

A Type 1 Brugada pattern independently predicted appropriate implantable cardioverter-defibrillator shock delivery (HR 2.07) in patients with Brugada syndrome.

Study Design

Type

Cohort (n=136)

Multicenter

Yes

Structured PICO

Population

136 Han Chinese patients with Brugada syndrome who received an implantable cardioverter-defibrillator, followed for a median of 95 months.

Exposure

Implantable cardioverter-defibrillator (ICD) implantation for primary or secondary prevention of sudden cardiac death

Outcome

Appropriate and inappropriate ICD shock deliveryhard clinical

In patients with Brugada syndrome, ICDs effectively treat ventricular arrhythmias, but inappropriate shocks and device complications are common, highlighting the need for careful risk stratification.

Main Result

Hazard Ratio: 2.07 (95% CI 1.05–4.06)

p-value: p=0.035

Limitations

Inconsistency in data collection due to multicenter retrospective design
ICD technology and settings evolved over the follow-up period
Lack of standardization in defining sustained VT/VF requiring shock
Appropriate shock as a surrogate for sudden cardiac death may overestimate death risk
Inability to access stored ICD data such as program settings and ECG waveforms

Abstract

BACKGROUND AND OBJECTIVES: Brugada syndrome (BrS) is a cardiac ion channelopathy with characteristic electrocardiographic patterns, predisposing affected individuals to sudden cardiac death (SCD). Implantable cardioverter-defibrillator (ICD) is used for primary or secondary prevention in BrS, but its use remains controversial amongst low-risk asymptomatic patients. The present study aims to examine indicators for ICD implantation amongst BrS patients with different disease manifestations. METHODS: This study included BrS patients who received ICDs between 1997 and 2018. The cohort was divided into three categories based on presentations before ICD implantation: asymptomatic, syncope, ventricular tachycardia/ventricular fibrillation (VT/VF). Univariate and multivariate Cox-regression analysis were performed to identify independent predictors of appropriate and inappropriate shock delivery. RESULTS: A total of 136 consecutive patients were included with a median follow-up of 95 (IQR: 80) months. Appropriate shocks were delivered in 34 patients (25.0%) whereas inappropriate shocks were delivered in 24 patients (17.6%). Complications occurred in 30 patients (22.1%). Type 1 Brugada pattern were found to be an independent predictor of appropriate shock delivery, whilst the presence of other arrhythmia was predictive for both appropriate and inappropriate ICD shock delivery under multivariate Cox regression analysis. CONCLUSION: ICD therapy is effective for primary and secondary prevention of SCD in BrS. Whilst appropriate shocks occur more frequently in BrS patients presenting with VT/VF, they also occur in asymptomatic patients. Further research in risk stratification can improve patient prognosis while avoid unnecessary ICD implantation.

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