Outcome after Implantation of Cardioverter-Defibrillator in Patients with Brugada Syndrome: A Multicenter Study - Part 2
Background—Implantable Cardioverter-Defibrillator (ICD) indications in Brugada Syndrome (BrS) remain controversial especially in asymptomatic patients. Previous outcome data is limited by relatively small number of patients or short follow-up duration. We report the outcome of BrS patients implanted with an ICD in a large multicenter registry.
Methods and Results—378 patients (310 male, 46±13years) with a type 1 Brugada ECG pattern implanted with an ICD (31 for aborted sudden cardiac arrest (SCA), 181 for syncope and 166 asymptomatic) were included. Fifteen patients (4%) were lost to follow-up. During a mean follow-up of 77±42 months, 7 patients (2%) died (1 due to inappropriate shock (IS)) and 46 patients (12%) had appropriate device therapy (5±5 shocks/patient). Appropriate device therapy rates at 10 years were 48% for patients whose ICD indication was aborted SCA, 19% for those whose indication was syncope and 12% for the patients who were asymptomatic at implantation. At 10 years, rates of IS and lead failure are 37% and 29%, respectively. IS occurred in 91 patients (24%, 4 ±4 shocks/patient) because of lead failure (n=38), supraventricular tachycardia (n=20), T-wave oversensing (n=14), or sinus tachycardia (n=12). Importantly, introduction of remote monitoring as well as programming a high single VF zone (>210/220bpm) and a long detection time were associated with a reduced risk of IS.
Conclusions—Appropriate therapies are more prevalent in symptomatic BrS patients but are not insignificant in asymptomatic patients (1%/year). Optimal ICD programming and follow-up reduce dramatically IS. However lead failure remains a major problem in this population.
- Received February 12, 2013.
- Revision received August 14, 2013.
- Accepted August 15, 2013.