Time-to-first appropriate shock in patients implanted prophylactically with an implantable cardioverter-defibrillator: data from the Survey on Arrhythmic Events in BRUgada Syndrome (SABRUS)

Anat Milman, Aviram Hochstadt, Antoine Andorin, Jean-Baptiste Gourraud, Frederic Sacher, Philippe Mabo, Sung-Hwan Kim, Giulio Conte, Elena Arbelo, Tsukasa Kamakura, Takeshi Aiba, Carlo Napolitano, Carla Giustetto, Isabelle Denjoy, Jimmy J M Juang, Shingo Maeda, Yoshihide Takahashi, Eran Leshem, Yoav Michowitz, Michael RahkovichCamilla H Jespersen, Yanushi D Wijeyeratne, Jean Champagne, Leonardo Calo, Zhengrong Huang, Yuka Mizusawa, Pieter G Postema, Ramon Brugada, Arthur A M Wilde, Gan-Xin Yan, Elijah R Behr, Jacob Tfelt-Hansen, Kenzo Hirao, Christian Veltmann, Antoine Leenhardt, Domenico Corrado, Fiorenzo Gaita, Silvia G Priori, Kengo F Kusano, Masahiko Takagi, Pietro Delise, Josep Brugada, Pedro Brugada, Gi-Byoung Nam, Vincent Probst, Bernard Belhassen

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Abstract

AIMS: Data on predictors of time-to-first appropriate implantable cardioverter-defibrillator (ICD) therapy in patients with Brugada Syndrome (BrS) and prophylactically implanted ICD's are scarce.

METHODS AND RESULTS: SABRUS (Survey on Arrhythmic Events in BRUgada Syndrome) is an international survey on 678 BrS patients who experienced arrhythmic event (AE) including 252 patients in whom AE occurred after prophylactic ICD implantation. Analysis was performed on time-to-first appropriate ICD discharge regarding patients' characteristics. Multivariate logistic regression models were utilized to identify which parameters predicted time to arrhythmia ≤5 years. The median time-to-first appropriate ICD therapy was 24.8 ± 2.8 months. A shorter time was observed in patients from Asian ethnicity (P < 0.05), those with syncope (P = 0.001), and those with Class IIa indication for ICD (P = 0.001). A longer time was associated with a positive family history of sudden cardiac death (P < 0.05). Multivariate Cox regression revealed shorter time-to-ICD therapy in patients with syncope [odds ratio (OR) 1.65, P = 0.001]. In 193 patients (76.6%), therapy was delivered during the first 5 years. Factors associated with this time were syncope (OR 0.36, P = 0.001), spontaneous Type 1 Brugada electrocardiogram (ECG) (OR 0.5, P < 0.05), and Class IIa indication (OR 0.38, P < 0.01) as opposed to Class IIb (OR 2.41, P < 0.01). A near-significant trend for female gender was also noted (OR 0.13, P = 0.052). Two score models for prediction of <5 years to shock were built.

CONCLUSION: First appropriate therapy in BrS patients with prophylactic ICD's occurred during the first 5 years in 76.6% of patients. Syncope and spontaneous Type 1 Brugada ECG correlated with a shorter time to ICD therapy.

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