Background— Implantable cardioverter-defibrillator indications in Brugada syndrome remain controversial, especially in asymptomatic patients. Previous outcome data are limited by relatively small numbers of patients or short follow-up durations. We report the outcome of patients with Brugada syndrome implanted with an implantable cardioverter-defibrillator in a large multicenter registry.

Methods and Results— A total of 378 patients (310 male; age, 46±13 years) with a type 1 Brugada ECG pattern implanted with an implantable cardioverter-defibrillator (31 for aborted sudden cardiac arrest, 181 for syncope, and 166 asymptomatic) were included. Fifteen patients (4%) were lost to follow-up. During a mean follow-up of 77±42 months, 7 patients (2%) died (1 as a result of an inappropriate shock), and 46 patients (12%) had appropriate device therapy (5±5 shocks per patient). Appropriate device therapy rates at 10 years were 48% for patients whose implantable cardioverter-defibrillator indication was aborted sudden cardiac arrest, 19% for those whose indication was syncope, and 12% for the patients who were asymptomatic at implantation. At 10 years, rates of inappropriate shock and lead failure were 37% and 29%, respectively. Inappropriate shock occurred in 91 patients (24%; 4±4 shocks per patient) because of lead failure (n=38), supraventricular tachycardia (n=20), T-wave oversensing (n=14), or sinus tachycardia (n=12). Importantly, introduction of remote monitoring, programming a high single ventricular fibrillation zone (>210–220 bpm), and a long detection time were associated with a reduced risk of inappropriate shock.

Conclusions— Appropriate therapies are more prevalent in symptomatic Brugada syndrome patients but are not insignificant in asymptomatic patients (1%/y). Optimal implantable cardioverter-defibrillator programming and follow-up dramatically reduce inappropriate shock. However, lead failure remains a major problem in this population.

# Clinical Perspective {#article-title-24}

Outcome After Implantation of a Cardioverter-Defibrillator in Patients With Brugada Syndrome A Multicenter Study

Background—Implantable cardioverter-defibrillator indications in Brugada syndrome remain controversial, especially in asymptomatic patients. Previous outcome data are limited by relatively small nu...

https://tamthuvn.com/Reprints/SacherBrugadaFollowup2006.pdf

Outcome After Implantation of a Cardioverter-Defibrillator in Patients With Brugada Syndrome

https://www.heartrhythmjournal.com/article/S1547-5271(15)01177-7/pdf

Implantable cardioverter-defibrillator harm in young patients with inherited arrhythmia syndromes: A systematic review and meta-analysis of inappropriate shocks and complications

Quinidine, a life-saving medication for Brugada syndrome, is inaccessible in many countries.

https://www.internationaljournalofcardiology.com/article/S0167-5273(13)01833-0/pdf

Socio-economic effects and cost saving potential of remote patient monitoring (SAVE-HM trial)

Outcome after implantable cardioverter-defibrillator in patients with Brugada syndrome: the Gulf Brugada syndrome registry

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Community’s 7th Framework Programme (HEALTH-F2-2009-602299) Ministry of Health, Czech Republic Background Three-dimensional (e.g., vectorcardiography) loops of normal physiologic QRS complex and T wave are known to be planar. Non-planarity of these electrocardiogram (ECG) loops was described in cardiac patients, mainly in relation to ischemic heart disease, but predictive values of the extent of non-planarity of the loops have not been systematically researched. Methods Pre-implantation digital ECGs were collected in 1948 cardiac patients (381 females, median age 65, inter-quartile range 56 – 72 years, 62% ischemic heart disease) who obtained an implantable cardioverter-defibrillator (ICD) for primary prophylactic reasons. In each ECG, QRS and T wave 3-dimensional loops were constructed using singular value decomposition and the non-planarity of the loops was measured as the relative power of the 3rd, least significant decomposition component. The non-planarity (i.e., the spatial twist) of the loops was related to all-cause mortality and to appropriate ICD shocks that occurred during the first 5 years after device implantation. This predictive power was compared to that of age, heart rate, left ventricular ejection fraction, QRS duration, spatial QRS-T angle, QTc interval, and T-peak to T-end interval. Results Non-planarity of the QRS loop was significantly associated with follow-up deaths despite ICD protection (p<0.001 both univariably and in multivariable Cox regression analysis) but was less powerfully associated with appropriate ICD shocks. Non-planarity of the T wave loop was significantly associated with appropriate ICD shocks during follow-up (p<0.001 both univariably and in multivariable Cox regression analysis) but was not associated with mortality during follow-up (Table). This was also seen in significant separation of Kaplan-Meier event probability curves (Figure). Conclusions The analysed data of recipients of prophylactic ICDs suggest that non-planarity of QRS complex and T wave loops offers distinction between patients who are at greater risk of death despite ICD protection and those who are likely to utilize the defibrillator protection. Table Figure

/pdf/qrs-complex-and-t-wave-planarity-for-the-prediction-of-death-1evanef8.pdf

Majed Malik

Papers

Outcome after implantable cardioverter-defibrillator in patients with Brugada syndrome: the Gulf Brugada syndrome registry

QRS complex and T wave planarity for the prediction of death and appropriate shocks in recipients of prophylactic implantable defibrillators