Risk stratification of individuals with the Brugada electrocardiogram: a meta-analysis.
OBJECTIVE
We performed a meta-analysis of prognostic studies of patients with a Brugada ECG to assess predictors of events.


BACKGROUND
The Brugada syndrome is an increasingly recognized cause of idiopathic ventricular fibrillation; however, there is wide variation in the prognosis of patients with the Brugada ECG.


RESULTS
We retrieved 30 prospective studies of patients with the Brugada ECG, accumulating data on 1,545 patients. Summary estimates of the relative risk (RR) of events (sudden cardiac death [SCD], syncope, or internal defibrillator shock) for a variety of potential predictors were made using a random-effects model. The overall event rate at an average of 32 months follow-up was 10.0% (95% CI 8.5%, 11.5%). The RR of an event was increased (P < 0.001) among patients with a history of syncope or SCD (RR 3.24 [95% CI 2.13, 4.93]), men compared with women (RR 3.47 [95% CI 1.58, 7.63]), and patients with a spontaneous compared with sodium-channel blocker induced Type I Brugada ECG (RR 4.65 [95% CI 2.25, 9.58]). The RR of events was not significantly increased in patients with a family history of SCD (P = 0.97) or a mutation of the SCN5A gene (P = 0.18). The RR of events was also not significantly increased in patients inducible compared with noninducible by electrophysiologic study (EPS) (RR 1.88 [95% CI 0.62, 5.73], P = 0.27); however, there was significant heterogeneity of the studies included.


CONCLUSIONS
Our findings suggest that a history of syncope or SCD, the presence of a spontaneous Type I Brugada ECG, and male gender predict a more malignant natural history. Our findings do not support the use of a family history of SCD, the presence of an SCN5A gene mutation, or EPS to guide the management of patients with a Brugada ECG.
Gehi
Anil K
AK
The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York 10029, USA. anil.gehi@msnyuhealth.org
Duong
Truong D
TD
Metz
Louise D
LD
Gomes
J Anthony
JA
Mehta
Davendra
D
D000328:Adult; D044466:Asian People; D053840:Brugada Syndrome / Q000150:complications* / Q000208:ethnology / Q000628:therapy; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D013575:Syncope / Q000209:etiology / Q000628:therapy; D013577:Syndrome; D014693:Ventricular Fibrillation / Q000208:ethnology / Q000209:etiology / Q000517:prevention & control; D044465:White People