Abstract 13263: Long-Term Prognosis and Risk Stratification in Brugada Syndrome: Single Center Experience.
Background: Risk stratification in Brugada syndrome (BS) has not been fully evaluated. We evaluated long-term prognosis and predictors for cardiac events in clinical, signal-averaged ECG (SAECG) and ECG characteristics in patients with BS.
Methods and Results: We enrolled a total of 112 consecutive individuals with BS (mean age 48+/−26 years, 106 males). Clinical, SAECG and ECG characteristics were evaluated among 3 groups of patients: VF group; patients with documented VF (N=14, mean age 51+/−28 years, all males), Syncope (Sy) group; patients with unknown syncope without documented VF (N=9, mean age 48+/−25 years, all males), Asymptomatic group (As); individuals without symptoms (N=89, mean age 48+/−25 years, 83 males). All patients had spontaneous or drug-induced type 1 ECG and underwent SAECG and ECG simultaneously at least four times. Comparisons were made among the 3 groups as well as between the symptomatic (VF/Sy) and asymptomatic (As) groups. During a mean follow-up of 50+/−29 months, incidences of VF episode were significantly higher in the VF (50%, N=7) and Sy (22%, N=2) groups than in the As (0%, N=0) group. The cardiac event rate per year was 21% in the VF group, 8.9% in the Sy group, 0% in the As group (p<0.05). In symptomatic patients, daily fluctuation of SAECG parameters and maximum QRS intervals in leads V1 and V2 were significantly larger in patients with VF recurrence than in patients without it (fQRS; 25+/−7 vs. 19+/−5 ms, LAS40; 30+/−10 vs. 21+/−5 ms, QRS interval in lead V1; 111+/−8 vs. 96+/−11 ms, and QRS interval in lead V2; 112+/−12 vs. 102+/−8 ms, P<0.05, respectively); . On multivariate analysis, daily fluctuation of SAECG parameters and maximum QRS interval in lead V1 were independent predictors of VF recurrence, whereas gender, family history of sudden cardiac death, spontaneous type 1 ECG, early repolarization in the inferolateral leads, and inducibility of VT/VF by electrophysiological study were not predictive of cardiac events.
Conclusions: Symptomatic patients had significantly higher rate of VF recurrence than asymptomatic individuals. In symptomatic patients, daily fluctuation in SAECG characteristics and QRS interval in precordial lead could be useful for distinguishing between high- and low-risk patients in BS.
- © 2010 by American Heart Association, Inc.