Role of programmed ventricular stimulation in patients with Brugada syndrome: a meta-analysis of worldwide published data.
OBJECTIVE
Brugada syndrome (BS) is an ion channelopathy with the risk of sudden cardiac death. The role of programmed ventricular stimulation (PVS) in risk stratification has been controversially discussed. Therefore, we performed a meta-analysis on the prognostic role of PVS in BS.


RESULTS
A Medline search until July 2006 documented 822 entries for BS. Only English publications with > 10 patients and a follow-up period were considered (n = 15). Patients [n = 1217; 974 males (80%)] were divided into three groups: survived sudden cardiac arrest (SCA) [n = 222 (18%)], syncope (Syncope) [n = 275 (23%)], and asymptomatic patients (Asympt) [n = 720 (59%)]. PVS was conducted in 1036 patients (85%). In 548 patients (53%), sustained ventricular tachyarrhythmias (VT) or ventricular fibrillation (VF) was inducible. During follow-up (34 +/- 40 months), VT/VF occurred in 141 patients. SCA bore the highest chance for a VT/VF occurrence during follow-up [odds ratio (OR) 14.4 compared with asymptomatic patients; P < 0.0005]. However, except for one study, the OR for VT/VF during follow-up in relation to VT/VF inducibility was non-significant (OR 1.5; P = ns).


CONCLUSIONS
The main finding is that we were unable to identify a significant role of PVS with regard to arrhythmic events during follow-up in BS, thus questioning the role of PVS for risk stratification in patients with BS. Patients with BS and survived SCA show the highest chance for VT/VF occurrence during follow-up.
Paul
Matthias
M
Department of Cardiology and Angiology, University Hospital of Muenster, Albert-Schweitzer-Str. 33, D-48149 Muenster, Germany. mapaul@uni-muenster.de
Gerss
Joachim
J
Schulze-Bahr
Eric
E
Wichter
Thomas
T
Vahlhaus
Christian
C
Wilde
Arthur A M
AA
Breithardt
Günter
G
Eckardt
Lars
L
D000328:Adult; D053840:Brugada Syndrome / Q000401:mortality / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000379:methods* / Q000401:mortality; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods / Q000401:mortality; D005260:Female; D006323:Heart Arrest / Q000209:etiology; D006801:Humans; D008297:Male; D018570:Risk Assessment; D013575:Syncope / Q000209:etiology; D017180:Tachycardia, Ventricular / Q000628:therapy; D016896:Treatment Outcome