In Brugada syndrome, malignant arrhythmias occurred in 15.7% of patients with suspected arrhythmic syncope and 7% with undefined syncope, compared to 0.7% with neurally-mediated syncope (P=0.0001).
Systematic Review (n=1,347)
Does the clinical type of syncope predict subsequent malignant arrhythmias in patients with Brugada syndrome?
In patients with Brugada syndrome, clinical classification of syncope helps stratify the risk of subsequent malignant arrhythmias, with neurally-mediated syncope carrying a very low risk compared to suspected arrhythmic or undefined syncope.
Absolute Event Rate: 15.7% vs 0.7%
p-value: p=0.0001
INTRODUCTION: Distinguishing syncope due to malignant arrhythmias from an incidental benign form in Brugada syndrome (BrS) is often difficult. Through systematic literature review, we evaluated the role of syncope in predicting subsequent malignant arrhythmias in BrS. METHODS: A comprehensive literature search was performed on PubMed (MeSH search terms "Brugada syndrome" and "syncope"). Overall, 9 studies for a total of 1347 patients were included. Patients were stratified as affected by suspected arrhythmic syncope (SAS), undefined syncope (US) or neurally-mediated syncope (NMS). RESULTS: Overall, 15.7% of the 279 patients with SAS had malignant arrhythmic events during a mean follow-up of 67 months, corresponding to 2.8 events per 100/person year. At the same time, 7% of the 527 patients affected by US had malignant arrhythmias during a mean follow-up of 39 months, corresponding 2.2 events per 100/person year. Conversely, 0.7% of 541 patients with NMS had malignant arrhythmic events at follow-up, corresponding to 0.13 events per 100/person year (p = .0001 NMS versus SAS and US pooled). CONCLUSION: In BrS population, the risk of arrhythmic events in the follow-up may be stratified according to the clinical evaluation. The "relatively" low predictive value of the clinical diagnosis of SAS warrants for a more accurate multi-parametric assessment, to restrict the number of candidates for implantable cardioverter-defibrillator therapy.
Mascia et al. (Thu,) conducted a systematic review in Brugada syndrome (n=1,347). Suspected arrhythmic syncope or undefined syncope vs. Neurally-mediated syncope was evaluated on Malignant arrhythmic events (p=0.0001). In Brugada syndrome, malignant arrhythmias occurred in 15.7% of patients with suspected arrhythmic syncope and 7% with undefined syncope, compared to 0.7% with neurally-mediated syncope (P=0.0001).
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