Implantable cardioverter-defibrillator therapy in Brugada syndrome: A 20-year single-center experience

Giulio Conte, Juan Sieira, Giuseppe Ciconte, Carlo De Asmundis, Gian Battista Chierchia, Giannis Baltogiannis, Giacomo Di Giovanni, Mark La Meir, Francis Wellens, Jens Czapla, Kristel Wauters, Moises Levinstein, Yukio Saitoh, Ghazala Irfan, Justo Julià, Gudrun Pappaert, Pedro Brugada

Research output: Contribution to journalArticle

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Abstract

Background Patients with Brugada syndrome and aborted sudden cardiac death or syncope have higher risks for ventricular arrhythmias (VAs) and should undergo implantable cardioverter-defibrillator (ICD) placement. Device-based management of asymptomatic patients is controversial. ICD therapy is associated with high rates of inappropriate shocks and device-related complications. Objectives The objective of this study was to investigate clinical features, management, and long-term follow-up of ICD therapy in patients with Brugada syndrome. Methods Patients presenting with spontaneous or drug-induced Brugada type 1 electrocardiographic findings, who underwent ICD implantation and continuous follow-up at a single institution, were eligible for this study. Results A total of 176 consecutive patients were included. During a mean follow-up period of 83.8 ± 57.3 months, spontaneous sustained VAs occurred in 30 patients (17%). Eight patients (4.5%) died. Appropriate ICD shocks occurred in 28 patients (15.9%), and 33 patients (18.7%) had inappropriate shocks. Electrical storm occurred in 4 subjects (2.3%). Twenty-eight patients (15.9%) experienced device-related complications. In multivariate Cox regression analysis, aborted sudden cardiac death and VA inducibility on electrophysiologic studies were independent predictors of appropriate shock occurrence. Conclusions ICD therapy was an effective strategy in Brugada syndrome, treating potentially lethal arrhythmias in 17% of patients during long-term follow-up. Appropriate shocks were significantly associated with the presence of aborted sudden cardiac death but also occurred in 13% of asymptomatic patients. Risk stratification by electrophysiologic study may identify asymptomatic patients at risk for arrhythmic events and could be helpful in investigating syncope not related to VAs. ICD placement is frequently associated with device-related complications, and rates of inappropriate shocks remain high regardless of careful device programming.

Original languageEnglish
Pages (from-to)879-888
Number of pages10
JournalJournal of the American College of Cardiology
Volume65
Issue number9
DOIs
Publication statusPublished - Mar 10 2015

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Brugada Syndrome
Implantable Defibrillators
Shock
Cardiac Arrhythmias
Therapeutics
Sudden Cardiac Death
Equipment and Supplies
Syncope

Keywords

  • Brugada syndrome
  • implantable cardioverter-defibrillator
  • sudden cardiac death
  • ventricular arrhythmias

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Implantable cardioverter-defibrillator therapy in Brugada syndrome : A 20-year single-center experience. / Conte, Giulio; Sieira, Juan; Ciconte, Giuseppe; De Asmundis, Carlo; Chierchia, Gian Battista; Baltogiannis, Giannis; Di Giovanni, Giacomo; La Meir, Mark; Wellens, Francis; Czapla, Jens; Wauters, Kristel; Levinstein, Moises; Saitoh, Yukio; Irfan, Ghazala; Julià, Justo; Pappaert, Gudrun; Brugada, Pedro.

In: Journal of the American College of Cardiology, Vol. 65, No. 9, 10.03.2015, p. 879-888.

Research output: Contribution to journalArticle

Conte, G, Sieira, J, Ciconte, G, De Asmundis, C, Chierchia, GB, Baltogiannis, G, Di Giovanni, G, La Meir, M, Wellens, F, Czapla, J, Wauters, K, Levinstein, M, Saitoh, Y, Irfan, G, Julià, J, Pappaert, G & Brugada, P 2015, 'Implantable cardioverter-defibrillator therapy in Brugada syndrome: A 20-year single-center experience', Journal of the American College of Cardiology, vol. 65, no. 9, pp. 879-888. https://doi.org/10.1016/j.jacc.2014.12.031
Conte, Giulio ; Sieira, Juan ; Ciconte, Giuseppe ; De Asmundis, Carlo ; Chierchia, Gian Battista ; Baltogiannis, Giannis ; Di Giovanni, Giacomo ; La Meir, Mark ; Wellens, Francis ; Czapla, Jens ; Wauters, Kristel ; Levinstein, Moises ; Saitoh, Yukio ; Irfan, Ghazala ; Julià, Justo ; Pappaert, Gudrun ; Brugada, Pedro. / Implantable cardioverter-defibrillator therapy in Brugada syndrome : A 20-year single-center experience. In: Journal of the American College of Cardiology. 2015 ; Vol. 65, No. 9. pp. 879-888.
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abstract = "Background Patients with Brugada syndrome and aborted sudden cardiac death or syncope have higher risks for ventricular arrhythmias (VAs) and should undergo implantable cardioverter-defibrillator (ICD) placement. Device-based management of asymptomatic patients is controversial. ICD therapy is associated with high rates of inappropriate shocks and device-related complications. Objectives The objective of this study was to investigate clinical features, management, and long-term follow-up of ICD therapy in patients with Brugada syndrome. Methods Patients presenting with spontaneous or drug-induced Brugada type 1 electrocardiographic findings, who underwent ICD implantation and continuous follow-up at a single institution, were eligible for this study. Results A total of 176 consecutive patients were included. During a mean follow-up period of 83.8 ± 57.3 months, spontaneous sustained VAs occurred in 30 patients (17{\%}). Eight patients (4.5{\%}) died. Appropriate ICD shocks occurred in 28 patients (15.9{\%}), and 33 patients (18.7{\%}) had inappropriate shocks. Electrical storm occurred in 4 subjects (2.3{\%}). Twenty-eight patients (15.9{\%}) experienced device-related complications. In multivariate Cox regression analysis, aborted sudden cardiac death and VA inducibility on electrophysiologic studies were independent predictors of appropriate shock occurrence. Conclusions ICD therapy was an effective strategy in Brugada syndrome, treating potentially lethal arrhythmias in 17{\%} of patients during long-term follow-up. Appropriate shocks were significantly associated with the presence of aborted sudden cardiac death but also occurred in 13{\%} of asymptomatic patients. Risk stratification by electrophysiologic study may identify asymptomatic patients at risk for arrhythmic events and could be helpful in investigating syncope not related to VAs. ICD placement is frequently associated with device-related complications, and rates of inappropriate shocks remain high regardless of careful device programming.",
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T1 - Implantable cardioverter-defibrillator therapy in Brugada syndrome

T2 - A 20-year single-center experience

AU - Conte, Giulio

AU - Sieira, Juan

AU - Ciconte, Giuseppe

AU - De Asmundis, Carlo

AU - Chierchia, Gian Battista

AU - Baltogiannis, Giannis

AU - Di Giovanni, Giacomo

AU - La Meir, Mark

AU - Wellens, Francis

AU - Czapla, Jens

AU - Wauters, Kristel

AU - Levinstein, Moises

AU - Saitoh, Yukio

AU - Irfan, Ghazala

AU - Julià, Justo

AU - Pappaert, Gudrun

AU - Brugada, Pedro

PY - 2015/3/10

Y1 - 2015/3/10

N2 - Background Patients with Brugada syndrome and aborted sudden cardiac death or syncope have higher risks for ventricular arrhythmias (VAs) and should undergo implantable cardioverter-defibrillator (ICD) placement. Device-based management of asymptomatic patients is controversial. ICD therapy is associated with high rates of inappropriate shocks and device-related complications. Objectives The objective of this study was to investigate clinical features, management, and long-term follow-up of ICD therapy in patients with Brugada syndrome. Methods Patients presenting with spontaneous or drug-induced Brugada type 1 electrocardiographic findings, who underwent ICD implantation and continuous follow-up at a single institution, were eligible for this study. Results A total of 176 consecutive patients were included. During a mean follow-up period of 83.8 ± 57.3 months, spontaneous sustained VAs occurred in 30 patients (17%). Eight patients (4.5%) died. Appropriate ICD shocks occurred in 28 patients (15.9%), and 33 patients (18.7%) had inappropriate shocks. Electrical storm occurred in 4 subjects (2.3%). Twenty-eight patients (15.9%) experienced device-related complications. In multivariate Cox regression analysis, aborted sudden cardiac death and VA inducibility on electrophysiologic studies were independent predictors of appropriate shock occurrence. Conclusions ICD therapy was an effective strategy in Brugada syndrome, treating potentially lethal arrhythmias in 17% of patients during long-term follow-up. Appropriate shocks were significantly associated with the presence of aborted sudden cardiac death but also occurred in 13% of asymptomatic patients. Risk stratification by electrophysiologic study may identify asymptomatic patients at risk for arrhythmic events and could be helpful in investigating syncope not related to VAs. ICD placement is frequently associated with device-related complications, and rates of inappropriate shocks remain high regardless of careful device programming.

AB - Background Patients with Brugada syndrome and aborted sudden cardiac death or syncope have higher risks for ventricular arrhythmias (VAs) and should undergo implantable cardioverter-defibrillator (ICD) placement. Device-based management of asymptomatic patients is controversial. ICD therapy is associated with high rates of inappropriate shocks and device-related complications. Objectives The objective of this study was to investigate clinical features, management, and long-term follow-up of ICD therapy in patients with Brugada syndrome. Methods Patients presenting with spontaneous or drug-induced Brugada type 1 electrocardiographic findings, who underwent ICD implantation and continuous follow-up at a single institution, were eligible for this study. Results A total of 176 consecutive patients were included. During a mean follow-up period of 83.8 ± 57.3 months, spontaneous sustained VAs occurred in 30 patients (17%). Eight patients (4.5%) died. Appropriate ICD shocks occurred in 28 patients (15.9%), and 33 patients (18.7%) had inappropriate shocks. Electrical storm occurred in 4 subjects (2.3%). Twenty-eight patients (15.9%) experienced device-related complications. In multivariate Cox regression analysis, aborted sudden cardiac death and VA inducibility on electrophysiologic studies were independent predictors of appropriate shock occurrence. Conclusions ICD therapy was an effective strategy in Brugada syndrome, treating potentially lethal arrhythmias in 17% of patients during long-term follow-up. Appropriate shocks were significantly associated with the presence of aborted sudden cardiac death but also occurred in 13% of asymptomatic patients. Risk stratification by electrophysiologic study may identify asymptomatic patients at risk for arrhythmic events and could be helpful in investigating syncope not related to VAs. ICD placement is frequently associated with device-related complications, and rates of inappropriate shocks remain high regardless of careful device programming.

KW - Brugada syndrome

KW - implantable cardioverter-defibrillator

KW - sudden cardiac death

KW - ventricular arrhythmias

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