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Journal Article•DOI•

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 Milman1, Aviram Hochstadt, Antoine Andorin, Jean-Baptiste Gourraud, Frédéric Sacher2, Philippe Mabo, Sung Hwan Kim3, Giulio Conte, Elena Arbelo4, Tsukasa Kamakura, Takeshi Aiba, Carlo Napolitano, Carla Giustetto5, Isabelle Denjoy6, Jimmy J.M. Juang7, Shingo Maeda8, Yoshihide Takahashi8, Eran Leshem9, Eran Leshem10, Yoav Michowitz9, Michael Rahkovich9, Michael Rahkovich11, Camilla H Jespersen12, Camilla H Jespersen13, Yanushi D. Wijeyeratne14, Jean Champagne, Leonardo Calò, Zhengrong Huang15, Yuka Mizusawa16, Pieter G Postema17, Ramon Brugada17, Arthur A.M. Wilde16, Gan-Xin Yan18, Elijah R. Behr14, Jacob Tfelt-Hansen12, Jacob Tfelt-Hansen13, Kenzo Hirao8, Christian Veltmann19, Antoine Leenhardt6, Domenico Corrado20, Fiorenzo Gaita5, Silvia G. Priori21, Kengo Kusano, Masahiko Takagi22, Pietro Delise, Josep Brugada4, Pedro Brugada, Gi-Byoung Nam23, Vincent Probst, Bernard Belhassen9 •
Sheba Medical Center1, French Institute of Health and Medical Research2, Catholic University of Korea3, Cardiovascular Institute of the South4, University of Turin5, Paris Diderot University6, National Taiwan University7, Tokyo Medical and Dental University8, Tel Aviv University9, Beth Israel Deaconess Medical Center10, Sunnybrook Health Sciences Centre11, Copenhagen University Hospital12, University of Copenhagen13, St George’s University Hospitals NHS Foundation Trust14, Xiamen University15, University of Amsterdam16, University of Girona17, Lankenau Medical Center18, Hannover Medical School19, University of Padua20, University of Pavia21, Kansai Medical University22, University of Ulsan23
01 May 2019-Europace (Oxford University Press)-Vol. 21, Iss: 5, pp 796-802
TL;DR: First appropriate therapy in BrS patients with prophylactic ICD's occurred during the first 5 years in 76.6% of patients and Syncope and spontaneous Type 1 Brugada ECG correlated with a shorter time to ICD therapy.
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.

Summary (2 min read)

Jump to: [INTRODUCTION] – [METHODS] – [Methods.] – [DATA ACQUISITION.] – [Time-to-shock.] and [Time-to-shock Score]

INTRODUCTION

  • Brugada syndrome (Brs) is a well-recognized cause of sudden cardiac death (SCD) particularly in apparently healthy middle-aged males(1).
  • The cause of death is a ventricular tachyarrhythmia usually occurring without precipitating warning signs(2) .
  • Most clinical research on this potentially lethal arrhythmic disease has mainly focused on risk stratification to identify patients at risk who will benefit from an implanted cardioverter-defibrillator (ICD), the most advocated option to prevent SCD.
  • Present indications for prophylactic ICD implantation in patients with BrS-ECG include(3): 1) Spontaneous type 1 Brugada-ECG pattern and a history of syncope (class IIa indication); 2) Spontaneous or drug-induced type 1 Brugada-ECG with induction of ventricular fibrillation during programmed ventricular stimulation with 2 or 3 extrastimuli (class IIb indication).
  • When a patient is identified as complying with these guideline recommendations(3), the most appropriate timing of the implantation is unknown with a double-edged sword decision for implant: too early might expose the patient to possible complications whereas too late might have a detrimental outcome.

METHODS

  • In 426 patients (group A), the AE was documented during aborted CA while in 252 patients (group B) the AE was documented from an ICD implanted prophylactically following conventional class IIa or IIb indications(3) (75% of patients) or non-class IIa or IIb indications (25% of patients)(2).
  • Group B patients comprised the study group of the present study.
  • The study was approved by the Research Ethics Boards of all participating institutions.

Methods.

  • SABRUS is an international survey on 678 BrS-patients who experienced arrhythmic event (AE) including 252 patients in whom AE occurred after prophylactic ICD implantation.
  • The median time-to-first appropriate ICD therapy was 24.8±2.8 months.
  • A longer time was associated with a positive family history of sudden cardiac death (p<0.05).
  • Two score models for prediction of <5 years to shock were built.
  • Syncope and spontaneous type 1 Brugada-ECG correlated with a shorter time to ICD therapy.

DATA ACQUISITION.

  • AE was defined as any sustained ventricular tachyarrhythmia triggering appropriate ICD shock therapy, also known as Arrhythmic events.
  • Taking into consideration the aforementioned patients’ characteristics predicting a time-to-shock < 5 years, their relative odds ratio, and parameter significance, two risks scores were built.
  • One point is given for either prior syncope or the presence of a spontaneous type 1 Brugada-ECG, and for the gender augmented score - 2 points were added for female gender.
  • A score of 0 was found in 50.0% of patients using the minimal score and in 46.4% of patients using the gender augmented score.

Time-to-shock.

  • The literature regarding the time-to-first appropriate shock therapy in BrS patients implanted prophylactically with an ICD is scarce.
  • In the present study which involved the largest cohort population with AEs documented after prophylactic ICD implantation (n=252), the median time-to-shock was 24.8 months.
  • By multivariate logistic regression the presence of syncope was found to correlate with a shorter time-to-shock (19.5±2.5 months vs. 36.5±4.9 months in asymptomatic patients, P<0.001).
  • One possible explanation could be a biased decision taken by the referring patient’s physician who considered a family history of SCD as a major risk factor.
  • In their recent paper(9) the authors discussed several factors suggesting a more aggressive course of the disease in females.

Time-to-shock Score

  • The time-to-shock score was created to help the identification of patients who will need an ICD implant with the shortest delays.
  • Because female gender had a borderline significance (p=0.052), which could be a result of the low number of 17 females included in the study, the authors created two scores one including gender and one excluding it.
  • Both scores showed high prediction rates for AE ≤ 5 years after ICD implant, yet the gender augmented score showed a more significant trend with a higher predictive value for the maximal score (85% for the maximal score in the minimal scoring system vs. 100% for the gender augmented system).
  • The present study by nature is a retrospective cumulative analysis of results from the largest EP-centers with experience with BrS.
  • Two factors (syncope and spontaneous type 1 BrS-ECG) were found to be associated with this time-to-shock delay.

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Europace
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)
--Manuscript Draft--
Manuscript Number: EUPC-D-18-01041R1
Full Title: 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)
Article Type: Clinical Research
Keywords: Brugada syndrome; ICD; appropriate therapy; arrhythmic event
Corresponding Author: Anat Milman, MD PhD
Tel Aviv Sourasky Medical Center
Tel Aviv, ISRAEL
Corresponding Author Secondary
Information:
Corresponding Author's Institution: Tel Aviv Sourasky Medical Center
Corresponding Author's Secondary
Institution:
Tel Aviv University Sackler Faculty of Medicine
First Author: Anat Milman, MD PhD
First Author Secondary Information:
Order of Authors: Anat Milman, MD PhD
Aviram Hochstadt, MD
Antoine Andorin, MD
Jean-Baptiste Gourraud, MD, PhD
Frederic Sacher, MD
Philippe Mabo, MD
Sung-Hwan Kim, MD
Giulio Conte, MD, PhD
Elena Arbelo, MD, PhD
Tsukasa Kamakura, MD, PhD
Takeshi Aiba, MD, PhD
Carlo Napolitano, MD, PhD
Carla Giustetto, MD
Isabelle Denjoy, MD
Jimmy JM Juang, MD, PhD
Shingo Maeda, MD, PhD
Yoshihide Takahashi, MD, PhD
Eran Leshem, MD
Yoav Michowitz, MD
Michael Rahkovich, MD
Camilla H. Jespersen, MD
Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation
Yanushi D. Wijeyeratne, MD
Jean Champagne, MD
Leonardo Calo, MD
Zhengrong Huang, MD, PhD
Yuka Mizusawa, MD
Pieter G. Postema, MD, PhD
Ramon Brugada, MD, PhD
Arthur A.M. Wilde, MD, PhD
Gan-Xin Yan, MD, PhD
Elijah R. Behr, MD
Jacob Tfelt-Hansen, MD, DMSc
Kenzo Hirao, MD, PhD
Christian Veltmann, MD
Antoine Leenhardt, MD
Domenico Corrado, MD, PhD
Fiorenzo Gaita, MD
Silvia G. Priori, MD, PhD
Kengo F. Kusano, MD, PhD
Masahiko Takagi, MD, PhD
Pietro Delise, MD
Josep Brugada, MD, PhD
Pedro Brugada, MD, PhD
Gi-Byoung Nam, MD, PhD
Vincent Probst, MD, PhD
Bernard Belhassen, MD
Order of Authors Secondary Information:
Abstract: Aims.
Data on predictors of time-to-first appropriate ICD therapy in patients with Brugada
syndrome (BrS) and prophylactically implanted ICD’s are scarce.
Methods.
SABRUS 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.
Results.
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 (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 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.
Conclusions.
Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation
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.
Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation
'What's New?'
1. In patients with BrS who had an appropriate shock from a prophylactically implanted
ICD, the great majority (76.6%) received this shock during the first 5 years after ICD
implantation.
2. Clinical parameters predicting a shorter time to appropriate shock were syncope and
a spontaneous type 1 ECG. A near-significant trend for female gender was also
noted.
3. Two score models were built using these parameters to predict the time to first AE
and will need to be validated in future studies.
"What's New"
ABSTRACT
Aims.
Data on predictors of time-to-first appropriate ICD therapy in patients with Brugada
syndrome (BrS) and prophylactically implanted ICD’s are scarce.
Methods.
SABRUS 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.
Results.
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 (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 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.
Conclusions.
First appropriate therapy in BrS-patients with prophylactic ICD’s occurred during the first 5
Abstract and Keywords
Citations
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Journal Article•DOI•
European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population

[...]

Jens Cosedis Nielsen1, Yenn Jiang Lin2, Márcio Jansen de Oliveira Figueiredo3, Alireza Sepehri Shamloo4, Alberto Alfie, Serge Boveda, Nikolaos Dagres4, Darío Di Toro5, Lee L. Eckhardt6, Kenneth A. Ellenbogen7, Carina Hardy8, Takanori Ikeda9, Aparna Jaswal, Elizabeth S. Kaufman10, Andrew D. Krahn11, Kengo Kusano, Valentina Kutyifa12, Valentina Kutyifa13, Han S. Lim14, Gregory Y.H. Lip15, Gregory Y.H. Lip16, Santiago Nava-Townsend, Hui Nam Pak17, Gerardo Rodriguez Diez18, William H. Sauer19, Anil Saxena, Jesper Hastrup Svendsen20, Diego Vanegas, Marmar Vaseghi21, Arthur A.M. Wilde22, T. Jared Bunch23, Alfred E. Buxton24, Gonzalo Calvimontes, Tze Fan Chao2, Lars Eckardt, Heidi Estner25, Anne M. Gillis26, Rodrigo Isa, Josef Kautzner, Philippe Maury, Joshua D. Moss27, Gi Byung Nam28, Brian Olshansky29, Luis Fernando Pava Molano, Mauricio Pimentel, Mukund A. Prabhu30, Wendy S. Tzou31, Philipp Sommer32, J. Swampillai33, Alejandro Vidal34, Thomas Deneke, Gerhard Hindricks4, Christophe Leclercq35 •
Aarhus University Hospital1, Taipei Veterans General Hospital2, State University of Campinas3, Leipzig University4, Argerich Hospital5, University of Wisconsin-Madison6, Virginia Commonwealth University7, University of São Paulo8, Toho University9, Case Western Reserve University10, University of British Columbia11, Semmelweis University12, University of Rochester Medical Center13, University of Melbourne14, Aalborg University15, University of Liverpool16, University Health System17, Institute for Social Security and Services for State Workers18, Brigham and Women's Hospital19, University of Copenhagen20, University of California, Los Angeles21, University of Amsterdam22, Intermountain Medical Center23, Beth Israel Deaconess Medical Center24, Ludwig Maximilian University of Munich25, Libin Cardiovascular Institute of Alberta26, University of California, San Francisco27, University of Ulsan28, Roy J. and Lucille A. Carver College of Medicine29, Sree Chitra Thirunal Institute for Medical Sciences and Technology30, Anschutz Medical Campus31, Ruhr University Bochum32, Waikato Hospital33, McGill University34, University of Rennes35
01 Aug 2020-Journal of Arrhythmia
TL;DR: This expert consensus statement task force was set down to raise awareness of using the right risk assessment tool for a given outcome in a given population, and to provide physicians with practical proposals that may lead to rational and evidence-based risk assessment and improvement of patient care in this regard.

62 citations

Journal Article•DOI•
Comparing the performance of published risk scores in Brugada syndrome: a multi-center cohort study.

[...]

Sharen Lee, Jiandong Zhou, C. Chung, Rebecca On Yu Lee, George Bazoukis, Konstantinos P. Letsas, Wing Tak Wong, Ian C. K. Wong, Ngai-Shing Mok, Tong Liu, Qingpeng Zhang, Gary Tse 
01 Sep 2022-Current Problems in Cardiology
TL;DR: In this article , the authors evaluated the predictive performance of different risk scores in an Asian Brugada Syndrome (BS) population and its intermediate risk subgroup and compared the area under the receiver operator characteristic curve (AUC) [95% confidence intervals] between the different models.

9 citations

Journal Article•DOI•
Performance of the entirely subcutaneous ICD in borderline indications.

[...]

Kevin Willy, Florian Reinke, Nils Bögeholz, Julia Köbe, Lars Eckardt, Gerrit Frommeyer 
01 Jun 2020-Clinical Research in Cardiology
TL;DR: The use of the S-ICD™ was safe in patients with borderline or unclear indication for ICD implantation in this study and may be considered as a possible alternative in cases of borderline indications and clinical uncertainty when decision pro- ICD implantation is made.
Abstract: The subcutaneous ICD (S-ICD™) is an important advance in device therapy for prevention of sudden cardiac death (SCD). In some patients, decision pro- or contra-ICD implantation is particularly challenging due to inconsistent data on risk of ventricular tachyarrhythmias or sudden cardiac death, rare entities, special medical or family history, or patients’ wishes. Whether decision-making in these borderline cases has been facilitated with the new option of a S-ICD™ is unknown. All patients with an implanted S-ICD™ without a class I or IIa recommendation for primary prophylaxis of sudden cardiac death in the current guidelines (n = 30 patients) in our large-scaled single-centre S-ICD™ registry (n = 249 patients) were included in this study. Baseline characteristics, appropriate and inappropriate shocks, and complications were documented in a mean follow-up of 40 months. In all patients S-ICD™ implantation was performed for primary prevention of SCD. Of all 30 patients with an overall mean age of 40.5 ± 15.6 years, 17 were male (57%). The mean left ventricular ejection fraction (LVEF) was 54.5 ± 9.9%. Indication were highly variable and ranged from structural heart disease, nsVT and LV-EF > 35% to patients with polymorphic non-sustained ventricular tachycardia (nsVT) and suspect syncope. During follow-up, six episodes of sustained ventricular tachyarrhythmias and four episodes of ventricular fibrillation (VF) were adequately terminated in three patients (10%). Two of these patients were implanted for polymorphic nsVT and previous syncope without structural heart disease. In three patients, T-wave-oversensing and in one patient also P-wave-oversensing resulted in an inappropriate shock (five in total), two additional episodes of oversensing ended before shock delivery. There were no S-ICD™ system-related infections. In five patients S-ICD™ replacement was performed due to battery depletion (four regular, one premature). In five patients, ablation procedures were performed after implantation (four because of frequent symptomatic ventricular extra beats, one because of atrial flutter). Change to a transvenous system was necessary in two patients due to need for antibradycardia pacing. The use of the S-ICD™ was safe in patients with borderline or unclear indication for ICD implantation in our study. Of note, during a relatively short mean follow-up there were several appropriate therapies, especially for VF in these patients. On the other hand, oversensing also occurred in about 10% of patients, while lead problems were not problematic in this collective. S-ICD™ implantation may be considered as a possible alternative in cases of borderline indications and clinical uncertainty when decision pro-ICD implantation is made. Incidence of arrhythmias was quite high and mostly consisted of VF. Nevertheless, patient education seems even more important as there is a considerable risk for inappropriate therapies as well.

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Journal Article•DOI•
Brugada syndrome: updated perspectives

[...]

Jagdeep Walia, Christian Steinberg, Zachary Laksman
04 Jun 2019-Research Reports in Clinical Cardiology
TL;DR: An in-depth review sheds light on the most important literature to date on Brugada syndrome, highlighting insights that shifted the global perspective on the disease.
Abstract: Jagdeep Walia Christian Steinberg Zachary Laksman 1Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada; 2Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Universite Laval, Québec, Canada Abstract: Since the first reported descriptions of Brugada syndrome, there has been a growing awareness and appreciation of the disease and its implications. From the diagnostic criteria, to risk stratification and management, there is an ongoing evolution, reclassification and re-thinking of Brugada syndrome as basic science, registry and clinical trial data shape our understanding of the pathophysiology and its clinical implications. This in-depth review sheds light on the most important literature to date, highlighting insights that shifted the global perspective on the disease. Current clinical paradigms and guidelines are presented, along with their justification, and possible opportunities for future research are explored.

6 citations

Journal Article•DOI•
Brugada Syndrome as a Major Cause of Sudden Cardiac Death in Asians

[...]

Yukiko Nakano, Wataru Shimizu
01 Jul 2022-JACC: Asia
TL;DR: In this paper , the authors focused on risk stratification of Brugada syndrome (BrS) patients and specifically on BrS patients of Asian descent, and focused specifically on the SCN5A gene that is the only gene responsible for BrS.

6 citations

References
More filters
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2015 ESC Guidelines for the Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death.

[...]

Silvia G. Priori, Carina Blomström-Lundqvist, Andrea Mazzanti, Nico A. Blom, Martin Borggrefe, John Camm, Perry M. Elliott, Donna Fitzsimons, Robert Hatala, Gerhard Hindricks, Paulus Kirchhof, Keld Kjeldsen, Karl Heinz Kuck, Antonio Hernández-Madrid, Nikolaos Nikolaou, Tone M. Norekvål, Christian Spaulding, Dirk J. van Veldhuisen 
01 Feb 2016-Revista Espanola De Cardiologia
TL;DR: This poster presents a probabilistic procedure to determine the best method for selecting a single drug to treat atrial fibrillation-like symptoms in patients with a history of atrialfibrillation.
Abstract: 2015 ESC Guidelines for the Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

2,109 citations

"Time-to-first appropriate shock in ..." refers background or methods in this paper

  • ...When a patient is identified as complying with these guideline recommendations(3), the most appropriate timing of the...

    [...]

  • ...Present indications for prophylactic ICD implantation in patients with BrS-ECG include(3): 1) Spontaneous type 1 Brugada-ECG pattern and a history of syncope (class IIa indication); 2) Spontaneous or drug-induced type 1 Brugada-ECG with induction of ventricular fibrillation during programmed ventricular stimulation with 2 or 3 extrastimuli (class IIb indication)....

    [...]

  • ...In 426 patients (group A), the AE was documented during aborted CA while in 252 patients (group B) the AE was documented from an ICD implanted prophylactically following conventional class IIa or IIb indications(3) (75% of patients) or non-class IIa or IIb indications (25% of patients)(2)....

    [...]

  • ...In respect to the conventional indications of prophylactic ICD implantation (3), the shortest median time-to-shock was observed in the class IIa subgroup (17....

    [...]

  • ...When a patient is identified as complying with these guideline recommendations(3), the most appropriate timing of the implantation is unknown with a double-edged sword decision for implant: too early might expose the patient to possible complications whereas too late might have a detrimental outcome....

    [...]

Journal Article•DOI•
2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC).

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01 Nov 2015-Europace
TL;DR: In this article, the authors proposed AMIOdarone versus implantable cardioverter-defibrillator (ICD-DV) for the treatment of atrial fibrillation.
Abstract: ACC : American College of Cardiology ACE : angiotensin-converting enzyme ACS : acute coronary syndrome AF : atrial fibrillation AGNES : Arrhythmia Genetics in the Netherlands AHA : American Heart Association AMIOVIRT : AMIOdarone Versus Implantable cardioverter-defibrillator:

1,513 citations

Journal Article•DOI•
2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

[...]

Silvia G. Priori1, Carina Blomström-Lundqvist2, Andrea Mazzanti, Nico A. Blom, Martin Borggrefe, John Camm, Perry M. Elliott, Donna Fitzsimons, Robert Hatala, Gerhard Hindricks, Paulus Kirchhof, Keld Kjeldsen, Karl Heinz Kuck, Antonio Hernández-Madrid, Nikolaos Nikolaou, Tone M. Norekvål, Christian Spaulding, Dirk J. van Veldhuisen •
University of Pavia1, Uppsala University2
01 Jan 2015-Kardiologia Polska
TL;DR: Authors/Task Force Members: Silvia G. Priori (Chairperson), Carina Blomström-Lundqvist (Co-chairperson) (Sweden), Andrea Mazzanti† (Italy), Nico Blom (The Netherlands), Martin Borggrefe (Germany), John Camm (UK), Perry Mark Elliott (UK).
Abstract: 2015 ESC Guidelines for the Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

945 citations

Journal Article•DOI•
Long-Term Prognosis of Patients Diagnosed With Brugada Syndrome Results From the FINGER Brugada Syndrome Registry

[...]

Vincent Probst1, Christian Veltmann2, Lars Eckardt3, Paola G. Meregalli, Fiorenzo Gaita4, Hanno L. Tan5, Dominique Babuty, Frederic Sacher6, Carla Giustetto4, Eric Schulze-Bahr3, Martin Borggrefe2, M. Haissaguerre6, Philippe Mabo, H. Le Marec7, Christian Wolpert2, Arthur A.M. Wilde5 •
French Institute of Health and Medical Research1, Heidelberg University2, University of Münster3, University of Turin4, University of Amsterdam5, University of Bordeaux6, University of Nantes7
09 Feb 2010-Circulation
TL;DR: In the largest series of Brugada syndrome patients thus far, event rates in asymptomatic patients were low and gender, familial history of SCD, inducibility of ventricular tachyarrhythmias during electrophysiological study, and the presence of an SCN5A mutation were not predictive of arrhythmic events.
Abstract: BACKGROUND: Brugada syndrome is characterized by ST-segment elevation in the right precordial leads and an increased risk of sudden cardiac death (SCD). Fundamental questions remain on the best strategy for assessing the real disease-associated arrhythmic risk, especially in asymptomatic patients. The aim of the present study was to evaluate the prognosis and risk factors of SCD in Brugada syndrome patients in the FINGER (France, Italy, Netherlands, Germany) Brugada syndrome registry. METHODS AND RESULTS: Patients were recruited in 11 tertiary centers in 4 European countries. Inclusion criteria consisted of a type 1 ECG present either at baseline or after drug challenge, after exclusion of diseases that mimic Brugada syndrome. The registry included 1029 consecutive individuals (745 men; 72%) with a median age of 45 (35 to 55) years. Diagnosis was based on (1) aborted SCD (6%); (2) syncope, otherwise unexplained (30%); and (3) asymptomatic patients (64%). During a median follow-up of 31.9 (14 to 54.4) months, 51 cardiac events (5%) occurred (44 patients experienced appropriate implantable cardioverter-defibrillator shocks, and 7 died suddenly). The cardiac event rate per year was 7.7% in patients with aborted SCD, 1.9% in patients with syncope, and 0.5% in asymptomatic patients. Symptoms and spontaneous type 1 ECG were predictors of arrhythmic events, whereas gender, familial history of SCD, inducibility of ventricular tachyarrhythmias during electrophysiological study, and the presence of an SCN5A mutation were not predictive of arrhythmic events. CONCLUSIONS: In the largest series of Brugada syndrome patients thus far, event rates in asymptomatic patients were low. Inducibility of ventricular tachyarrhythmia and family history of SCD were not predictors of cardiac events.

754 citations

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

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Frederic Sacher1, Vincent Probst, Yoshito Iesaka, Peggy Jacon, Julien Laborderie, Frederique Mizon-Gerard, Philippe Mabo, Sylvain Reuter, Dominique Lamaison, Yoshihide Takahashi, Mark D O'Neill, Stéphane Garrigue, Bertrand Pierre, Pierre Jaïs2, Jean-Luc Pasquié, Mélèze Hocini2, Michèle Salvador-Mazenq, Akihiko Nogami, Alain Amiel, Pascal Defaye, Pierre Bordachar2, Serge Boveda, Philippe Maury, Didier Klug2, Dominique Babuty, Michel Haïssaguerre2, Jacques Mansourati, Jacques Clementy2, Hervé Le Marec •
University of Bordeaux1, French Institute of Health and Medical Research2
28 Nov 2006-Circulation
TL;DR: Optimal implantable cardioverter-defibrillator programming and follow-up dramatically reduce inappropriate shock in patients with Brugada syndrome, but lead failure remains a major problem in this population.
Abstract: 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}

425 citations

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Frequently Asked Questions (1)
Q1. What have the authors contributed in "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)" ?

In this paper, the authors used multivariate logistic regression models to identify which parameters predicted time to arrhythmia ≤ 5 years.