Cited by 581Cardiac electrophysiology and arrhythmiasCardiac Arrhythmias and TreatmentsCardiac pacing and defibrillation studies

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Risk Stratification in Brugada Syndrome

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Abstract

Objectives The PRELUDE (PRogrammed ELectrical stimUlation preDictive valuE) prospective registry was designed to assess the predictive accuracy of sustained ventricular tachycardia/ventricular fibrillation (VTs/VF) inducibility and to identify additional predictors of arrhythmic events in Brugada syndrome patients without history of VT/VF.Background Brugada syndrome is a genetic disease associated with increased risk of sudden cardiac death. Even though its value has been questioned, inducibility of VTs/VF is widely used to select candidates to receive a prophylactic implantable defibrillator, and its accuracy has never been addressed in prospective studies with homogeneous enrolling criteria.Methods Patients with a spontaneous or drug-induced type I electrocardiogram (ECG) and without history of cardiac arrest were enrolled. The registry included 308 consecutive individuals (247 men, 80%; median age 44 years, range 18 to 72 years). Programmed electrical stimulation was performed at enrollment, and patients were followed-up every 6 months.Results During a median follow-up of 34 months, 14 arrhythmic events (4.5%) occurred (13 appropriate shocks of the implantable defibrillator, and 1 cardiac arrest). Programmed electrical stimulation performed with a uniform and pre-specified protocol induced ventricular tachyarrhythmias in 40% of patients: arrhythmia inducibility was not a predictor of events at follow-up (9 of 14 events occurred in noninducible patients). History of syncope and spontaneous type I ECG (hazard ratio [HR]: 4.20), ventricular refractory period <200 ms (HR: 3.91), and QRS fragmentation (HR: 4.94) were significant predictors of arrhythmias.Conclusions Our data show that VT/VF inducibility is unable to identify high-risk patients, whereas the presence of a spontaneous type I ECG, history of syncope, ventricular effective refractory period <200 ms, and QRS fragmentation seem useful to identify candidates for prophylactic implantable cardioverter defibrillator.

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Metadata

Authors
Priori, S. G., Gasparini, M., Napolitano, C., Della Bella, P., Ottonelli, A. G., Sassone, B., Giordano, U., Pappone, C., Mascioli, G., Rossetti, G., De Nardis, R., & Colombo, M.
Affiliations
  • University of Pavia (IT)
  • IRCCS Humanitas Research Hospital (IT)
  • NYU Langone Health (US)
  • Ospedale Versilia (IT)
  • Azienda USL di Bologna (IT)
  • Maria Cecilia Hospital (IT)
  • Humanitas Gavazzeni (IT)
  • Azienda Sanitaria Ospedaliera S.Croce e Carle Cuneo (IT)
Corresponding author
Priori, Silvia G.
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2012-01
Volume
59
Issue
1
Pages
37-45
ISSN
0735-1097 (ISSN-L)
OpenAlex
W140924846
Cited by
581
References
26
Citations by year
2026: 13 · 2025: 14 · 2024: 26 · 2023: 25 · 2022: 26 · 2021: 44 · 2020: 43 · 2019: 44 · 2018: 44 · 2017: 68 · 2016: 60 · 2015: 45 · 2014: 31 · 2013: 66 · 2012: 30
FWCI
28.05
Type
journal article
Language
en
Open access
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
  • Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
  • Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion)
Funders
  • Medtronic
  • Boston Scientific Corporation
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Keywords
Brugada syndrome, risk stratification, programmed electrical stimulation, implantable cardioverter-defibrillator, sudden cardiac death, syncope, ventricular effective refractory period, QRS fragmentation, arrhythmic events
MeSH terms
Adolescent, Adult, Aged, Cause of Death, Electric Stimulation, Electrocardiography, Female, Humans, Male, Middle Aged, Registries, Severity of Illness Index, Ventricular Fibrillation, Cohort Studies, Incidence, Survival Rate, Confidence Intervals, Defibrillators, Implantable, Tachycardia, Ventricular, Age Distribution, Sex Distribution, Risk Assessment, Patient Selection, Statistics, Nonparametric, Kaplan-Meier Estimate, Brugada Syndrome, Young Adult

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