title: Regional prevalence and clinical benefit of implantable cardioverter defibrillators in Brugada syndrome.
abstract: BACKGROUND
  Brugada syndrome (BS) is associated with an increased risk of sudden cardiac death (SCD) caused by ventricular tachyarrhythmia. Thus, implantable cardioverter defibrillators (ICD) became the main therapeutic option in these patients. We aimed to investigate the prevalence of BS in the Eastern Alps as well as the benefit of ICD therapy in this collective.
  
  
  METHODS
  During physical examination before military service, 47,606 Austrian men were screened for Brugada ECG pattern. Furthermore, we followed 4491 patients with arrhythmia during the last two decades, of which 26 patients (20 male; age at diagnosis: 43.2 ± 11.6 years) revealed BS. Diagnosis was based on characteristic ECG either at rest (11 patients) or after provocation with Ajmaline (15 patients).
  
  
  RESULTS
  The nationwide screening revealed one individual with Brugada ECG (prevalence of 2.10/100,000 inhabitants). Prior to diagnosis of BS, syncope and SCD survival were observed in 7 and 4 patients, respectively; the remaining 15 patients were asymptomatic. ICD were implanted in 17 patients (15 male). Three asymptomatic patients received no ICD because no tachyarrhythmia was inducible on programmed stimulation. Six asymptomatic patients without family history of sudden death refused further evaluation. Mean ICD follow-up period was 57.0 ± 32.2 months. Two patients (11.7%) needed defibrillation therapy. Four patients (23.5%) received exclusively inappropriate shocks (three due to T-wave oversensing, one due to atrial fibrillation).
  
  
  CONCLUSIONS
  Brugada syndrome has a low prevalence in the Eastern alpine region. Patients with BS benefit from ICD implantation, but less frequently than anticipated. The problem of inappropriate ICD discharges is still of major concern.
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria. christoph.schukro@meduniwien.ac.at
authors.forename: Christoph
authors.initials: C
authors.lastname: Schukro
authors.forename: Thomas
authors.initials: T
authors.lastname: Berger
authors.forename: Günter
authors.initials: G
authors.lastname: Stix
authors.forename: Thomas
authors.initials: T
authors.lastname: Pezawas
authors.forename: Johannes
authors.initials: J
authors.lastname: Kastner
authors.forename: Florian
authors.initials: F
authors.lastname: Hintringer
authors.forename: Herwig
authors.initials: H
authors.lastname: Schmidinger
mesh_terms: D000328:Adult; D001317:Austria; D053840:Brugada Syndrome / Q000453:epidemiology* / Q000628:therapy*; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies