title: Risk stratification in patients with Brugada syndrome without previous cardiac arrest – prognostic value of combined risk factors.
abstract: BACKGROUND
  Risk stratification in patients with Brugada syndrome for primary prevention of sudden cardiac death is still an unsettled issue. A recent consensus statement suggested the indication of implantable cardioverter defibrillator (ICD) depending on the clinical risk factors present (spontaneous type 1 Brugada electrocardiogram (ECG) [Sp1], history of syncope [syncope], and ventricular fibrillation during programmed electrical stimulation [PES+]). The indication of ICD for the majority of patients, however, remains unclear.
  
  
  RESULTS
  A total of 218 consecutive patients (211 male; aged 46 ± 13 years) with a type 1 Brugada ECG without a history of cardiac arrest who underwent evaluation for ICD including electrophysiological testing were examined retrospectively. During a mean follow-up period of 78 months, 26 patients (12%) developed arrhythmic events. On Kaplan-Meier analysis patients with each of Sp1, syncope, or PES+ suffered arrhythmic events more frequently (P=0.018, P<0.001, and P=0.003, respectively). On multivariate analysis Sp1 and syncope were independent predictors of arrhythmic events. When dividing patients according to the number of these 3 risk factors present, patients with 2 or 3 risk factors experienced arrhythmic events more frequently than those with 0 or 1 risk factor (23/93 vs. 3/125; P<0.001).
  
  
  CONCLUSIONS
  Syncope, Sp1, and PES+ are important risk factors and the combination of these risks well stratify the risk of later arrhythmic events.
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan..
authors.forename: Hideo
authors.initials: H
authors.lastname: Okamura
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Kamakura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Morita
authors.forename: Koji
authors.initials: K
authors.lastname: Tokioka
authors.forename: Ikutaro
authors.initials: I
authors.lastname: Nakajima
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Wada
authors.forename: Kohei
authors.initials: K
authors.lastname: Ishibashi
authors.forename: Koji
authors.initials: K
authors.lastname: Miyamoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Noda
authors.forename: Takeshi
authors.initials: T
authors.lastname: Aiba
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Nishii
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nagase
authors.forename: Wataru
authors.initials: W
authors.lastname: Shimizu
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yasuda
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
authors.forename: Shiro
authors.initials: S
authors.lastname: Kamakura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
authors.forename: Tohru
authors.initials: T
authors.lastname: Ohe
authors.forename: Kengo F
authors.initials: KF
authors.lastname: Kusano
mesh_terms: D000328:Adult; D053840:Brugada Syndrome / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013575:Syncope / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology