title: Outcome after implantation of a cardioverter-defibrillator in patients with Brugada syndrome: a multicenter study.
abstract: 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.
authors.affiliation: Université Bordeaux II, Hôpital Cardiologique du Haut-Lévêque, 33604 Bordeaux-Pessac, France. frederic.sacher@chu-bordeaux.fr
authors.forename: Frédéric
authors.initials: F
authors.lastname: Sacher
authors.forename: Vincent
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authors.forename: Yoshito
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authors.lastname: Iesaka
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authors.lastname: Laborderie
authors.forename: Frédérique
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authors.forename: Philippe
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authors.lastname: Mabo
authors.forename: Sylvain
authors.initials: S
authors.lastname: Reuter
authors.forename: Dominique
authors.initials: D
authors.lastname: Lamaison
authors.forename: Yoshihide
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authors.lastname: Takahashi
authors.forename: Mark D
authors.initials: MD
authors.lastname: O'Neill
authors.forename: Stéphane
authors.initials: S
authors.lastname: Garrigue
authors.forename: Bertrand
authors.initials: B
authors.lastname: Pierre
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Pasquié
authors.forename: Mélèze
authors.initials: M
authors.lastname: Hocini
authors.forename: Michèle
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authors.lastname: Salvador-Mazenq
authors.forename: Akihiko
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authors.lastname: Nogami
authors.forename: Alain
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authors.lastname: Amiel
authors.forename: Pascal
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authors.lastname: Defaye
authors.forename: Pierre
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authors.lastname: Bordachar
authors.forename: Serge
authors.initials: S
authors.lastname: Boveda
authors.forename: Philippe
authors.initials: P
authors.lastname: Maury
authors.forename: Didier
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authors.lastname: Klug
authors.forename: Dominique
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authors.lastname: Babuty
authors.forename: Michel
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authors.lastname: Haïssaguerre
authors.forename: Jacques
authors.initials: J
authors.lastname: Mansourati
authors.forename: Jacques
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authors.lastname: Clémenty
authors.forename: Hervé
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authors.lastname: Le Marec
mesh_terms: 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