Abstract 12966: Clinical Aspects and Prognosis of Elderly Patients with Brugada Syndrome
Background: Little is known about the clinical characteristics and prognosis of elderly patients with Brugada syndrome (BrS).
Methods and Results: This study included 60 patients (mean age 71.3±5.4 years, 58 males) with type-1 Brugada-pattern electrocardiogram (ECG) (spontaneous:43, sodium channel blocker induced:17) who were more than 65 years old at the last follow-up visit. At the time of admission, 6 patients had a history of ventricular fibrillation (VF) (VF group), 22 had experienced a syncope (Syncope group), and 32 (spontaneous type-1:25) were asymptomatic (Asymptomatic group). Thirty-seven patients were diagnosed with BrS, including 9 patients in the Asymptomatic group who were diagnosed based on positive electrophysiological study (EPS) (n=4), or a family history (FH) of sudden cardiac death (SCD) (n=1), or both (n=4). Atrial fibrillation was noticed in 20 patients. An implantable cardioverter defibrillator (ICD) was implanted in 28 patients (VF:6, Syncope:16, Asymptomatic:6). During a mean follow-up of 100±88 months, 2 patients in the VF group (33.3%) and 5 patients in the Syncope group (22.7%) received an appropriate ICD shock due to VF. No patients experienced SCD. After the second VF attack, quinidine was administered in 3 patients; even so 2 patients developed VF. One patient treated with cilostazol in the Syncope group did not have a recurrence. The age at the first attack was less than 70 years (range 43-69 years) in all 11 patients who experienced VF. VF recurred in only 1 patient (1.7%) with spontaneous type-1 ECG in the Syncope group after 70 years of age. No patients in the Asymptomatic group including those with positive EPS or a FH of SCD developed VF. Fifteen of 28 patients (53.6%) with an implanted ICD experienced ICD complications, including inappropriate shocks in 12 patients, lead failure requiring reimplantation in 2 patients, and pocket infection in one patient.
Conclusions: In this cohort of elderly BrS patients, the first VF occurred before the age of 70 years in all patients, and VF seldom recurred after the age of 70 years. Considering a significant number of ICD complications, the implantation of ICD should involve risk/benefit considerations, especially in asymptomatic elderly patients with Brugada-pattern ECG.
- © 2013 by American Heart Association, Inc.