title: Risk stratification in Brugada syndrome: results of the PRELUDE (PRogrammed ELectrical stimUlation preDictive valuE) registry.
abstract: OBJECTIVE
  The PRELUDE (PRogrammed ELectrical stimUlation preDictive valuE) prospective registry was designed to assess the predictive accuracy of sustained ventricular tachycardia/ventricular fibrillation (VTs/VF) inducibility and to identify additional predictors of arrhythmic events in Brugada syndrome patients without history of VT/VF.
  
  
  BACKGROUND
  Brugada syndrome is a genetic disease associated with increased risk of sudden cardiac death. Even though its value has been questioned, inducibility of VTs/VF is widely used to select candidates to receive a prophylactic implantable defibrillator, and its accuracy has never been addressed in prospective studies with homogeneous enrolling criteria.
  
  
  METHODS
  Patients with a spontaneous or drug-induced type I electrocardiogram (ECG) and without history of cardiac arrest were enrolled. The registry included 308 consecutive individuals (247 men, 80%; median age 44 years, range 18 to 72 years). Programmed electrical stimulation was performed at enrollment, and patients were followed-up every 6 months.
  
  
  RESULTS
  During a median follow-up of 34 months, 14 arrhythmic events (4.5%) occurred (13 appropriate shocks of the implantable defibrillator, and 1 cardiac arrest). Programmed electrical stimulation performed with a uniform and pre-specified protocol induced ventricular tachyarrhythmias in 40% of patients: arrhythmia inducibility was not a predictor of events at follow-up (9 of 14 events occurred in noninducible patients). History of syncope and spontaneous type I ECG (hazard ratio [HR]: 4.20), ventricular refractory period <200 ms (HR: 3.91), and QRS fragmentation (HR: 4.94) were significant predictors of arrhythmias.
  
  
  CONCLUSIONS
  Our data show that VT/VF inducibility is unable to identify high-risk patients, whereas the presence of a spontaneous type I ECG, history of syncope, ventricular effective refractory period <200 ms, and QRS fragmentation seem useful to identify candidates for prophylactic implantable cardioverter defibrillator.
authors.affiliation: Cardiologia Molecolare, IRCCS Fondazione Salvatore Maugeri, Via Maugeri 10/10a, Pavia, Italy. silvia.priori@fsm.it
authors.forename: Silvia G
authors.initials: SG
authors.lastname: Priori
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gasparini
authors.forename: Carlo
authors.initials: C
authors.lastname: Napolitano
authors.forename: Paolo
authors.initials: P
authors.lastname: Della Bella
authors.forename: Andrea Ghidini
authors.initials: AG
authors.lastname: Ottonelli
authors.forename: Biagio
authors.initials: B
authors.lastname: Sassone
authors.forename: Umberto
authors.initials: U
authors.lastname: Giordano
authors.forename: Carlo
authors.initials: C
authors.lastname: Pappone
authors.forename: Giosuè
authors.initials: G
authors.lastname: Mascioli
authors.forename: Guido
authors.initials: G
authors.lastname: Rossetti
authors.forename: Roberto
authors.initials: R
authors.lastname: De Nardis
authors.forename: Mario
authors.initials: M
authors.lastname: Colombo
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D053840:Brugada Syndrome / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D017147:Defibrillators, Implantable; D004558:Electric Stimulation / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000453:epidemiology*; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000453:epidemiology*; D055815:Young Adult