title: Long-term follow-up in patients with presumptive Brugada syndrome treated with implanted defibrillators.
abstract: BACKGROUND
  Risk stratification for patients with suspected Brugada syndrome (BS) remains difficult. Implantation of cardioverter-defibrillators (ICDs) in high-risk patients provides continuous long-term arrhythmia protection.
  
  
  METHODS
  Data of 33 consecutive patients undergoing ICD implantation after BS evaluation between 1995 and 2008 were reviewed.
  
  
  RESULTS
  There were 30 (91%) men and 3 (9%) women (46.4 ± 11.7 years). Type I Brugada was noted in 18 (54.5%), type II in 12 (36.4%) patients, and ST elevation after drug challenge in 3 patients (9.1%). Three patients had prior cardiac arrest; 70% a history of syncope; and 56% ventricular arrhythmias at the electrophysiology study. During 7.9 ± 3.6 years of follow-up, 2 patients with prior arrest received appropriate ICD shocks. None of the 30 patients without prior arrest had a sustained arrhythmia detected. ICD-related adverse effects occurred in 11 (33%) patients, including inappropriate shocks in 5 (15%). Eight patients (24%) developed 11 major device-related complications including subclavian vein thrombosis (1), pericardial effusion (1), lead fracture (2), and infection (2); in 4 patients the only complication was premature battery depletion that required early ICD replacement; however, some of these complications such as lead fractures and early battery depletion may not be specific for this patient cohort and may not repeat in the future.
  
  
  CONCLUSIONS
  Risk stratification for patients with BS for primary prevention remains challenging. The low risk of arrhythmic events that is exceeded by ICD-related adverse effects should inform discussions with patients who do not have a prior history of cardiac arrest.
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. dsteven@uke.de
authors.forename: Daniel
authors.initials: D
authors.lastname: Steven
authors.forename: Kurt C
authors.initials: KC
authors.lastname: Roberts-Thomson
authors.forename: Keiichi
authors.initials: K
authors.lastname: Inada
authors.forename: Jens
authors.initials: J
authors.lastname: Seiler
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Koplan
authors.forename: Usha B
authors.initials: UB
authors.lastname: Tedrow
authors.forename: Michel O
authors.initials: MO
authors.lastname: Sweeney
authors.forename: Laurence E
authors.initials: LE
authors.lastname: Epstein
authors.forename: William G
authors.initials: WG
authors.lastname: Stevenson
mesh_terms: D000328:Adult; D001900:Boston; D053840:Brugada Syndrome / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000009:adverse effects; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation*; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011475:Prosthesis Failure; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome