New-onset atrial fibrillation as first clinical manifestation of latent Brugada syndrome: Prevalence and clinical significance

Carlo Pappone, Andrea Radinovic, Francesco Manguso, Gabriele Vicedomini, Simone Sala, Francesco Maria Sacco, Giuseppe Ciconte, Massimo Saviano, Maurizio Ferrari, Elena Sommariva, Stefania Sacchi, Cristiano Ciaccio, Eleftherios M. Kallergis, Vincenzo Santinelli

Research output: Contribution to journalArticle

Abstract

Aims: To evaluate the prevalence, clinical significance, and prognosis of latent Brugada syndrome (BrS) in patients with new-onset atrial fibrillation (AF) unmasked by class 1C antiarrhythmic drugs.Methods and resultsBetween January 2000 and June 2008, all consecutive patients with new-onset AF, who after flecainide exhibited typical Brugada ECG pattern, underwent electrophysiologic, pharmacologic, and genetic testing. Among 346 patients [median age 53 years; interquartile range (IQR), 15], 11 (3.2; median age 51 years; IQR, 19) diagnosed as lone AF exhibited typical Brugada ECG pattern. Genetic testing was negative. Ventricular tachycardia/ventricular fibrillation (VT/VF) was induced by electrophysiologic testing (five patients) or during flecainide infusion (one patient). Six patients with type 1 ECG pattern and inducible VT/VF underwent ICD implantation. During a median follow-up of 31.5 months (range: 10-85) after ICD implantation, three patients developed BrS and one of them experienced VF. Patients without ICD (five patients) remained asymptomatic during a median follow-up of 74 months. Persistent type 1 pattern occurred only in the three patients who developed BrS.ConclusionThis study, for the first time, reveals the prevalence of latent BrS in patients with new-onset lone AF, which may precede VT/VF. Persistence of type 1 and ventricular tachyarrhythmias inducibility represents a marker of electrical instability leading to sudden death.

Original languageEnglish
Pages (from-to)2985-2992
Number of pages8
JournalEuropean Heart Journal
Volume30
Issue number24
DOIs
Publication statusPublished - Dec 2009

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Keywords

  • Atrial fibrillation
  • Brugada syndrome
  • Sudden cardiac death

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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