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Risk Stratification in Brugada Syndrome
Open accessAbstract
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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“A drug-induced type 1 ECG pattern has a lower risk of sudden death than a spontaneous type 1 response.”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [371]
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Self-citationProgrammed Electrical Stimulation in Brugada Syndrome: How Reproducible Are the Results?
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Priori, S. G., Blomström-Lundqvist, C., Mazzanti, A., Blom, N., Borggrefe, M., Camm, J., Elliott, P. M., Fitzsimons, D., Hatala, R., Hindricks, G., et al. (2015) · European Heart Journal · doi:10.1093/eurheartj/ehv316 · Cited by 3,893
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Self-citation2018 ESC Guidelines for the diagnosis and management of syncope
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“[73]; 6% event rate at 34 ± 44 months by Priori et al.[70]; 1% event rate after 40 ± 50 months and 30 ± 21 months of follow-up, respectively by Eckardt et al.”
BackgroundResultInfluentialSelf-citationAl‐Khatib, S. M., Stevenson, W. G., Ackerman, M. J., Bryant, W. J., Callans, D. J., Curtis, A. B., Deal, B. J., Dickfeld, T. M., Field, M. E., Fonarow, G. C., et al. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.10.054 · Cited by 1,902
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.
- ORCID
- 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
- bronze
- doi.org
- Licence
- 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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