title: Outcome after implantation of a cardioverter-defibrillator in patients with Brugada syndrome: a multicenter study-part 2.
abstract: BACKGROUND
  Implantable cardioverter-defibrillator indications in Brugada syndrome remain controversial, especially in asymptomatic patients. Previous outcome data are limited by relatively small numbers of patients or short follow-up durations. We report the outcome of patients with Brugada syndrome implanted with an implantable cardioverter-defibrillator in a large multicenter registry.
  
  
  RESULTS
  A total of 378 patients (310 male; age, 46±13 years) with a type 1 Brugada ECG pattern implanted with an implantable cardioverter-defibrillator (31 for aborted sudden cardiac arrest, 181 for syncope, and 166 asymptomatic) were included. Fifteen patients (4%) were lost to follow-up. During a mean follow-up of 77±42 months, 7 patients (2%) died (1 as a result of an inappropriate shock), and 46 patients (12%) had appropriate device therapy (5±5 shocks per patient). Appropriate device therapy rates at 10 years were 48% for patients whose implantable cardioverter-defibrillator indication was aborted sudden cardiac arrest, 19% for those whose indication was syncope, and 12% for the patients who were asymptomatic at implantation. At 10 years, rates of inappropriate shock and lead failure were 37% and 29%, respectively. Inappropriate shock occurred in 91 patients (24%; 4±4 shocks per patient) because of lead failure (n=38), supraventricular tachycardia (n=20), T-wave oversensing (n=14), or sinus tachycardia (n=12). Importantly, introduction of remote monitoring, programming a high single ventricular fibrillation zone (>210-220 bpm), and a long detection time were associated with a reduced risk of inappropriate shock.
  
  
  CONCLUSIONS
  Appropriate therapies are more prevalent in symptomatic Brugada syndrome patients but are not insignificant in asymptomatic patients (1%/y). Optimal implantable cardioverter-defibrillator programming and follow-up dramatically reduce inappropriate shock. However, lead failure remains a major problem in this population.
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, L'Institut de Rythmologie et de Modelisation Cardiaque, INSERM 1045, Bordeaux, France (F.S., A.D., C.L., M.E.F., N.D., A.D., P.R., S.P., A.Z., P.B., P.J., M.H., M.H.); Institut du Thorax, CHU de Nantes, Nantes, France (V.P., J.-B.G.); CHU de Toulouse, Toulouse, France (P. Maury, A. Rollin); CHU de Tours, Tours, France (D.B., B.P.); CHU de Brest, Brest, France (J.M., S.M.); Tsuchiura Kyodo Hospital, Tsuchiura, Japan (Y.K., Y.I.); CHU de Lille, Lille, France (C.M.); Clinique Pasteur, Toulouse, France (A. Rosa, S.B.); CHU de Grenoble, Grenoble, France (R.C., P.D.); CHU de Rennes, Rennes, France (R.M., P. Mabo); Yokohama Rosai Hospital, Yokohama, Japan (A.N.); CHU de Clermont-Ferrand, Clermont-Ferrand, France (D.L.); CHU de Montpellier, Montpellier, France (J.-L.P.); and CHU de Poitiers, Poiters, France (F.L.).
authors.forename: Frédéric
authors.initials: F
authors.lastname: Sacher
authors.forename: Vincent
authors.initials: V
authors.lastname: Probst
authors.forename: Philippe
authors.initials: P
authors.lastname: Maury
authors.forename: Dominique
authors.initials: D
authors.lastname: Babuty
authors.forename: Jacques
authors.initials: J
authors.lastname: Mansourati
authors.forename: Yuki
authors.initials: Y
authors.lastname: Komatsu
authors.forename: Christelle
authors.initials: C
authors.lastname: Marquie
authors.forename: Antonio
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authors.lastname: Rosa
authors.forename: Abou
authors.initials: A
authors.lastname: Diallo
authors.forename: Romain
authors.initials: R
authors.lastname: Cassagneau
authors.forename: Claire
authors.initials: C
authors.lastname: Loizeau
authors.forename: Raphael
authors.initials: R
authors.lastname: Martins
authors.forename: Michael E
authors.initials: ME
authors.lastname: Field
authors.forename: Nicolas
authors.initials: N
authors.lastname: Derval
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Miyazaki
authors.forename: Arnaud
authors.initials: A
authors.lastname: Denis
authors.forename: Akihiko
authors.initials: A
authors.lastname: Nogami
authors.forename: Philippe
authors.initials: P
authors.lastname: Ritter
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Gourraud
authors.forename: Sylvain
authors.initials: S
authors.lastname: Ploux
authors.forename: Anne
authors.initials: A
authors.lastname: Rollin
authors.forename: Adlane
authors.initials: A
authors.lastname: Zemmoura
authors.forename: Dominique
authors.initials: D
authors.lastname: Lamaison
authors.forename: Pierre
authors.initials: P
authors.lastname: Bordachar
authors.forename: Bertrand
authors.initials: B
authors.lastname: Pierre
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Pasquié
authors.forename: Mélèze
authors.initials: M
authors.lastname: Hocini
authors.forename: François
authors.initials: F
authors.lastname: Legal
authors.forename: Pascal
authors.initials: P
authors.lastname: Defaye
authors.forename: Serge
authors.initials: S
authors.lastname: Boveda
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Iesaka
authors.forename: Philippe
authors.initials: P
authors.lastname: Mabo
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
mesh_terms: D000328:Adult; D000368:Aged; D053840:Brugada Syndrome / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000009:adverse effects / Q000706:statistics & numerical data*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Brugada syndrome; death, sudden, cardiac; defibrillators, implantable