Meta-Analysis on Risk Stratification of Asymptomatic Individuals With the Brugada Phenotype.
The prognosis of asymptomatic subjects remains the most controversial issue in Brugada syndrome (BS). A meta-analysis on the prognostic role of spontaneous type 1 electrocardiographic (ECG) pattern and programmed ventricular stimulation (PVS) in asymptomatic subjects with Brugada electrocardiogram was performed. Current databases were searched until March 2014. Fourteen prospective observational studies were included in the present meta-analysis, accumulating data on 3,536 asymptomatic subjects (2,820 men) with BS phenotype. The mean follow-up period varied from 20 and 77 months. Data regarding 1,398 asymptomatic subjects with spontaneous type 1 ECG pattern of BS were retrieved from 6 studies. During follow-up, arrhythmic events (sustained ventricular tachycardia/fibrillation, appropriate device therapies, or arrhythmic death) occurred in 42 patients (3%). The meta-analysis of these studies demonstrated that asymptomatic subjects with spontaneous type 1 ECG pattern of BS exhibit an increased risk of future arrhythmic events (odds ratio = 3.56, 95% confidence interval 1.70 to 7.47, Z = 3.37, p = 0.0008); 1,104 asymptomatic subjects with BS ECG pattern from 12 studies underwent PVS and were available for analysis. During follow-up, arrhythmic events occurred in 36 subjects (3.3%). Inducible ventricular arrhythmias at PVS were predictive of future arrhythmic events (odds ratio = 3.51, 95% confidence interval 1.60 to 7.67, Z = 3.14, p = 0.002). In conclusion, this meta-analysis showed that asymptomatic subjects with either spontaneous diagnostic ECG pattern or inducible ventricular arrhythmias at PVS are at increased risk.
Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece. Electronic address: letsaskpa@yahoo.co.uk.
Konstantinos P
KP
Letsas
Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China.
Tong
T
Liu
Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China.
Qingmiao
Q
Shao
Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece.
Panagiotis
P
Korantzopoulos
Department of Cardiology, Athens General Hospital "G. Gennimatas," Athens, Greece.
Georgios
G
Giannopoulos
Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece.
Konstantinos
K
Vlachos
Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece.
Stamatis
S
Georgopoulos
Department of Cardiology, "Elpis" General Hospital of Athens, Athens, Greece.
Athanasios
A
Trikas
Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece.
Michael
M
Efremidis
Department of Cardiology, Athens General Hospital "G. Gennimatas," Athens, Greece.
Spyridon
S
Deftereos
Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece.
Antonios
A
Sideris
D053840:Brugada Syndrome / Q000175:diagnosis* / Q000503:physiopathology*; D003937:Diagnosis, Differential; D004562:Electrocardiography; D019317:Evidence-Based Medicine; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D010641:Phenotype; D011379:Prognosis; D018570:Risk Assessment