Arrhythmias & electrophysiology
Implantable Cardioverter-Defibrillator Therapy in Brugada Syndrome: A 30-Year Single-Center Experience
Authors' conclusion
This 30-year study highlights ICD therapy's critical role in preventing fatal arrhythmias in Brugada syndrome, but also reveals frequent device-related complications, especially in younger patients. Thoracoscopic epicardial ablation significantly reduced VA in high-risk patients, offering a promising adjunctive therapy. These findings emphasize the need for individualized treatment strategies to balance the benefits of ICDs with their risks, and underscore the potential of ablation to improve long-term outcomes.
Study context
- Population
- Patients with Brugada syndrome (Brugada type 1 electrocardiogram pattern, spontaneous or drug induced) who received implantable cardioverter-defibrillator (ICDs)consecutive Brugada patients who received ICDs from 1992 to 2022
- Participants
- 306 patients
- Exposure
- Secondary prevention ICDs compared to primary prevention ICDs
- Outcome
- Baseline characteristics
Methodological detailsconsecutive, single institution, 1992 to 2022
- Consecutive
- Single institution
- 1992 to 2022
Main finding
As reported in the abstract
Male
186 male
61%
Mean age
41 ± 17 years
Age range
1-82 years
ICDs implanted for secondary prevention
16%
Observational data: associations, not effects.
Further findings
At least 1 sustained ventricular arrhythmia (VA) · median 103 months [63-147 months]
- Patients with at least 1 sustained VA
- 14%
- Rate
- 1.59 per 100 person-years
Ventricular and supraventricular arrhythmias
- Higher incidence with secondary prevention ICDs than with primary prevention ICDs
Predictors of sustained VAs
- Loss-of-function mutations and prior nonsustained VAs associated with sustained VAs
Ventricular events among high-risk patients, epicardial ablation
- Significantly fewer ventricular events with epicardial ablation
Mortality
- Overall mortality rate
- 5.88%
- Deaths attributed to cardiac causes
- 22.2%
Trends over 3 decades
- Proportions of secondary prevention implants and asymptomatic patients remained stable
Safety
Inappropriate ICD shock · median 103 months [63-147 months]
- At least 1 inappropriate ICD shock
- 15%
- Unaffected by the presence of single or dual leads
Device revision and/or lead replacement · median 103 months [63-147 months]
- Required device revision and/or lead replacement
- 27%
Original publication
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