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Cited by 199Cardiac electrophysiology and arrhythmiasCardiac pacing and defibrillation studiesCardiac Arrhythmias and Treatments

Implantable Cardioverter-Defibrillator Therapy in Brugada Syndrome

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Conte, Giulio, Sieira, Juan, Ciconte, Giuseppe, de Asmundis, Carlo, Chierchia, Gian-Battista, Baltogiannis, Giannis, Di Giovanni, Giacomo, La Meir, Mark +9 more·2015·Journal of the American College of Cardiology
DOI 10.1016/j.jacc.2014.12.031
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Abstract

Background Patients with Brugada syndrome and aborted sudden cardiac death or syncope have higher risks for ventricular arrhythmias (VAs) and should undergo implantable cardioverter-defibrillator (ICD) placement. Device-based management of asymptomatic patients is controversial. ICD therapy is associated with high rates of inappropriate shocks and device-related complications.Objectives The objective of this study was to investigate clinical features, management, and long-term follow-up of ICD therapy in patients with Brugada syndrome.Methods Patients presenting with spontaneous or drug-induced Brugada type 1 electrocardiographic findings, who underwent ICD implantation and continuous follow-up at a single institution, were eligible for this study.Results A total of 176 consecutive patients were included. During a mean follow-up period of 83.8 ± 57.3 months, spontaneous sustained VAs occurred in 30 patients (17%). Eight patients (4.5%) died. Appropriate ICD shocks occurred in 28 patients (15.9%), and 33 patients (18.7%) had inappropriate shocks. Electrical storm occurred in 4 subjects (2.3%). Twenty-eight patients (15.9%) experienced device-related complications. In multivariate Cox regression analysis, aborted sudden cardiac death and VA inducibility on electrophysiologic studies were independent predictors of appropriate shock occurrence.Conclusions ICD therapy was an effective strategy in Brugada syndrome, treating potentially lethal arrhythmias in 17% of patients during long-term follow-up. Appropriate shocks were significantly associated with the presence of aborted sudden cardiac death but also occurred in 13% of asymptomatic patients. Risk stratification by electrophysiologic study may identify asymptomatic patients at risk for arrhythmic events and could be helpful in investigating syncope not related to VAs. ICD placement is frequently associated with device-related complications, and rates of inappropriate shocks remain high regardless of careful device programming.

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  • A history of syncope in patients with structural heart disease or inheritable arrhythmia syndromes is associated with a two- to four-fold increased risk of death, but this varies between specific conditions.

    “In general, a history of syncope in patients with structural heart disease or inheritable arrhythmia syndromes is associated with a two- to four-fold increased risk of death, 348,350-353 but varies between specific conditions. 354-356”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [355]

  • In a second study, the rate of appropriate ICD shocks was similar in asymptomatic patients and in those with syncope, a difference possibly explained by patient selection and a high rate of non-arrhythmic syncope.

    “However, in a second study, the rate of appropriate ICD shocks was similar in asymptomatic patients and in those with syncope, a difference possibly explained by patient selection and a high rate of non-arrhythmic syncope. 355”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [355]

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Authors
Conte, G., Sieira, J., Ciconte, G., de Asmundis, C., Chierchia, G.-B., Baltogiannis, G., Di Giovanni, G., La Meir, M., Wellens, F., Czapla, J., Wauters, K., Levinstein, M., Saitoh, Y., Irfan, G., Julià, J., Pappaert, G., & Brugada, P.
Affiliations
  • Universitair Ziekenhuis Brussel (BE)
  • Vrije Universiteit Brussel (BE)
Corresponding author
Conte, Giulio
ORCID
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2015-03
Volume
65
Issue
9
Pages
879-888
ISSN
0735-1097 (ISSN-L)
DOI
10.1016/j.jacc.2014.12.031
OpenAlex
W96548030
Cited by
199
References
23
Citations by year
2026: 7 · 2025: 13 · 2024: 15 · 2023: 12 · 2022: 15 · 2021: 8 · 2020: 16 · 2019: 20 · 2018: 20 · 2017: 34 · 2016: 28 · 2015: 11
FWCI
22.54
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
  • Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
  • VUBIR (Vrije Universiteit Brussel) (submittedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
Keywords
Brugada syndrome, implantable cardioverter-defibrillator, ventricular arrhythmias, aborted sudden cardiac death, syncope, inappropriate shocks, device complications, electrical storm, electrophysiological study, risk stratification, long-term follow-up, appropriate shocks
MeSH terms
Adolescent, Adrenergic beta-Antagonists, Adult, Aged, Anti-Arrhythmia Agents, Belgium, Child, Child, Preschool, Death, Sudden, Electrocardiography, Female, Follow-Up Studies, Humans, Male, Middle Aged, Sotalol, Syncope, Time Factors, Multivariate Analysis, Defibrillators, Implantable, Tachycardia, Ventricular, Brugada Syndrome, Young Adult

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