Outcome after implantation of a cardioverter-defibrillator in patients with Brugada syndrome: a multicenter study.
BACKGROUND
Brugada syndrome is an arrhythmogenic disease characterized by an increased risk of sudden cardiac death (SCD) by ventricular fibrillation. At present, an implantable cardioverter-defibrillator (ICD) is the recommended therapy in high-risk patients. This multicenter study reports the outcome of a large series of patients implanted with an ICD for Brugada syndrome.


RESULTS
All patients (n=220, 46+/-12 years, 183 male) with a type 1 Brugada ECG pattern implanted with an ICD in 14 centers between 1993 and 2005 were investigated. ICD indication was based on resuscitated SCD (18 patients, 8%), syncope (88 patients, 40%), or positive electrophysiological study in asymptomatic patients (99 patients, 45%). The remaining 15 patients received an ICD because of a family history of SCD or nonsustained ventricular arrhythmia. During a mean follow-up of 38+/-27 months, no patient died and 18 patients (8%) had appropriate device therapy (10+/-15 shocks/patient, 26+/-33 months after implantation). The complication rate was 28%, including inappropriate shocks, which occurred in 45 patients (20%, 4+/-3 shocks/patient, 21+/-20 months after implantation). The reasons for inappropriate therapy were lead failure (19 patients), T-wave oversensing (10 patients), sinus tachycardia (10 patients), and supraventricular tachycardia (9 patients). Among implantation parameters, high defibrillation threshold, high pacing threshold, and low R-wave amplitude occurred, respectively, in 12%, 27%, and 15% of cases.


CONCLUSIONS
In this large Brugada syndrome population, a low incidence of arrhythmic events was found, with an annual event rate of 2.6% during a follow-up of >3 years, in addition to a significant risk of device-related complications (8.9%/year). Inappropriate shocks were 2.5 times more frequent than appropriate ones.
Sacher
Frédéric
F
Université Bordeaux II, Hôpital Cardiologique du Haut-Lévêque, 33604 Bordeaux-Pessac, France. frederic.sacher@chu-bordeaux.fr
Probst
Vincent
V
Iesaka
Yoshito
Y
Jacon
Peggy
P
Laborderie
Julien
J
Mizon-Gérard
Frédérique
F
Mabo
Philippe
P
Reuter
Sylvain
S
Lamaison
Dominique
D
Takahashi
Yoshihide
Y
O'Neill
Mark D
MD
Garrigue
Stéphane
S
Pierre
Bertrand
B
Jaïs
Pierre
P
Pasquié
Jean-Luc
JL
Hocini
Mélèze
M
Salvador-Mazenq
Michèle
M
Nogami
Akihiko
A
Amiel
Alain
A
Defaye
Pascal
P
Bordachar
Pierre
P
Boveda
Serge
S
Maury
Philippe
P
Klug
Didier
D
Babuty
Dominique
D
Haïssaguerre
Michel
M
Mansourati
Jacques
J
Clémenty
Jacques
J
Le Marec
Hervé
H
D000328:Adult; D053840:Brugada Syndrome / Q000175:diagnosis / Q000235:genetics / Q000503:physiopathology / Q000628:therapy*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000379:methods*; D004562:Electrocardiography; D004594:Electrophysiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D012151:Resuscitation; D012189:Retrospective Studies; D013575:Syncope; D016896:Treatment Outcome