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
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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.
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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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'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
