title: Outcome after implantation of cardioverter defibrillator [corrected] in patients with Brugada syndrome: a multicenter Israeli study (ISRABRU).
abstract: BACKGROUND
  Many electrophysiologists recommend implantable cardioverter defibrillators for patients with Brugada syndrome who are cardiac arrest survivors or presumed at high risk of sudden death (patients with syncope or a familial history of sudden death or those with inducible ventricular fibrillation at electrophysiologic study).
  
  
  OBJECTIVE
  To assess the efficacy and complications of ICD therapy in patients with Brugada syndrome.
  
  
  METHODS
  The indications, efficacy and complications of ICD therapy in all patients with Brugada syndrome who underwent ICD implantation in 12 Israeli centers between 1994 and 2007 were analyzed.
  
  
  RESULTS
  There were 59 patients (53 males, 89.8%) with a mean age of 44.1 years. At diagnosis 42 patients (71.2%) were symptomatic while 17 (28.8%) were asymptomatic. The indications for ICD implantation were: a history of cardiac arrest (n = 11, 18.6%), syncope (n = 31, 52.5%), inducible VF in asymptomatic patients (n = 14, 23.7%), and a family history of sudden death (n = 3, 0.5%). The overall inducibility rates of VF were 89.2% and 93.3% among the symptomatic and asymptomatic patients, respectively (P = NS). During a follow-up of 4-160 (45 +/- 35) months, all patients (except one who died from cancer) are alive. Five patients (8.4%), all with a history of cardiac arrest, had appropriate ICD discharge. Conversely, none of the patients without prior cardiac arrest had appropriate device therapy during a 39 +/- 30 month follow-up. Complications were encountered in 19 patients (32%). Inappropriate shocks occurred in 16 (27.1%) due to lead failure/dislodgment (n = 5), T wave oversensing (n = 2), device failure (n = 1), sinus tachycardia (n = 4), and supraventricular tachycardia (n = 4). One patient suffered a pneumothorax and another a brachial plexus injury during the implant procedure. One patient suffered a late (2 months) perforation of the right ventricle by the implanted lead. Eleven patients (18.6%) required a reintervention either for infection (n = 1) or lead problems (n = 10). Eight patients (13.5%) required psychiatric assistance due to complications related to the ICD (mostly inappropriate shocks in 7 patients).
  
  
  CONCLUSIONS
  In this Israeli population with Brugada syndrome treated with ICD, appropriate device therapy was limited to cardiac arrest survivors while none of the other patients including those with syncope and/or inducible VF suffered an arrhythmic event. The overall complication rate was high.
authors.affiliation: Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Raphael
authors.initials: R
authors.lastname: Rosso
authors.forename: Aharon
authors.initials: A
authors.lastname: Glick
authors.forename: Michael
authors.initials: M
authors.lastname: Glikson
authors.forename: Abraham
authors.initials: A
authors.lastname: Wagshal
authors.forename: Moshe
authors.initials: M
authors.lastname: Swissa
authors.forename: Shimon
authors.initials: S
authors.lastname: Rosenhek
authors.forename: Israel
authors.initials: I
authors.lastname: Shetboun
authors.forename: Vladimir
authors.initials: V
authors.lastname: Khalamizer
authors.forename: Therese
authors.initials: T
authors.lastname: Fuchs
authors.forename: Munther
authors.initials: M
authors.lastname: Boulos
authors.forename: Michael
authors.initials: M
authors.lastname: Geist
authors.forename: Boris
authors.initials: B
authors.lastname: Strasberg
authors.forename: Michael
authors.initials: M
authors.lastname: Ilan
authors.forename: Bernard
authors.initials: B
authors.lastname: Belhassen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D053840:Brugada Syndrome / Q000628:therapy*; D017147:Defibrillators, Implantable / Q000009:adverse effects; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome