Journal
HEART RHYTHM
Volume 18, Issue 5, Pages 664-671Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.hrthm.2020.12.020
Keywords
Brugada syndrome; Electrophysiological study; Sudden cardiac death; Ventricular arrhythmias; Women
Categories
Funding
- Instituto de Salud Carlos III [FIS PI16/01203, PI17/01690]
- ERDF/ESF, Investing in Your Future
- CERCA Programme/Generalitat de Catalunya
- Fundacio Daniel Bravo Andreu
- Obra Social La Caixa
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Male predominance in Brugada syndrome is common, but there is limited information on female patients. This study found that females with BrS present differently from males in terms of symptoms, ECG patterns, and family history. Genetic testing and atrial fibrillation were identified as risk factors for future arrhythmic events in women with BrS.
BACKGROUND A male predominance in Brugada syndrome (BrS) has been widely reported, but scarce information on female patients with BrS is available. OBJECTIVE The purpose of this study was to investigate clinical characteristics and long-term prognosis of women with BrS. METHODS A multicenter retrospective study of patients diagnosed with BrS and previous electrophysiological study (EPS) was performed. RESULTS Among 770 patients, 177 (23%) were female. At presentation, 150 (84.7%) were asymptomatic. Females presented less frequently with a type 1 electrocardiographic pattern (30.5% vs 55.0%; P <.001), had a higher rate of family history of sudden cardiac death (49.7% vs 29.8%; P <.001), and had less sustained ventricular arrhythmias (VAs) on EPS (8.5% vs 15.1%; P = .009). Genetic testing was performed in 79 females (45% of the sample) and was positive in 34 (19%). An implantable cardioverter-defibrillator was inserted in 48 females (27.1%). During mean (+/- SD) follow-up of 122.17 +/- 57.28 months, 5 females (2.8%) experienced a cardiovascular event compared to 42 males (7.1%; P = .04). On multivariable analysis, a positive genetic test (18.71; 95% confidence interval [CI] 1.82-192.53; P = .01) and atrial fibrillation (odds ratio 21.12; 95% CI 1.27-350.85; P = .03) were predictive of arrhythmic events, whereas VAs on EPS (neither with 1 or 2 extrastimuli nor 3 extrastimuli) were not. CONCLUSION Women with BrS represent a minor fraction among patients with BrS, and although their rate of events is low, they do not constitute a risk-free group. Neither clinical risk factors nor EPS predicts future arrhythmic events. Only atrial fibrillation and positive genetic test were identified as risk factors for future arrhythmic events.
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