Journal
CIRCULATION JOURNAL
Volume 79, Issue 2, Pages 310-+Publisher
JAPANESE CIRCULATION SOC
DOI: 10.1253/circj.CJ-14-1059
Keywords
Brugada syndrome; Electrophysiological study; Primary prevention; Risk stratification; Syncope
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Funding
- Ministry of Health, Labor, and Welfare [H24-033]
- Grants-in-Aid for Scientific Research [24591086, 24591051] Funding Source: KAKEN
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Background: Risk stratification in patients with Brugada syndrome for primary prevention of sudden cardiac death is still an unsettled issue. A recent consensus statement suggested the indication of implantable cardioverter defibrillator (ICD) depending on the clinical risk factors present (spontaneous type 1 Brugada electrocardiogram (ECG) [Sp1], history of syncope [syncope], and ventricular fibrillation during programmed electrical stimulation [PES+]). The indication of ICD for the majority of patients, however, remains unclear. Methods and Results: A total of 218 consecutive patients (211 male; aged 46 +/- 13 years) with a type 1 Brugada ECG without a history of cardiac arrest who underwent evaluation for ICD including electrophysiological testing were examined retrospectively. During a mean follow-up period of 78 months, 26 patients (12%) developed arrhythmic events. On Kaplan-Meier analysis patients with each of Sp1, syncope, or PES+ suffered arrhythmic events more frequently (P=0.018, P<0.001, and P=0.003, respectively). On multivariate analysis Sp1 and syncope were independent predictors of arrhythmic events. When dividing patients according to the number of these 3 risk factors present, patients with 2 or 3 risk factors experienced arrhythmic events more frequently than those with 0 or 1 risk factor (23/93 vs. 3/125; P<0.001). Conclusions: Syncope, Sp1, and PES+ are important risk factors and the combination of these risks well stratify the risk of later arrhythmic events.
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