title: Evaluation of the necessity for cardioverter-defibrillator implantation in elderly patients with Brugada syndrome.
abstract: BACKGROUND
  The clinical characteristics and prognosis of elderly patients with Brugada syndrome (BrS) are largely unknown. The purpose of this study was to evaluate the risks and benefits of implantable cardioverter defibrillator (ICD) in elderly patients with BrS based on a long follow-up.
  
  
  RESULTS
  A total of 120 BrS patients with ICD (90 for aborted sudden cardiac arrest or syncope, mean age, 46.6±12.2 years; 50 with age ≥60 years at the last follow-up) were included in this study. During 102±68 months of follow-up, 31 patients (26%) experienced appropriate shocks. Age at the first attack of ventricular fibrillation (VF) was <70 years in all patients (mean, 45.0±12.1 years), the incidence of VF decreased with age, and VF did not recur after 70 years of age except in 2 patients with ischemic heart disease. Eleven of 28 patients with supraventricular tachycardia experienced inappropriate shocks. These inappropriate shocks increased with age and reached a peak in patients who were in their sixties. Lead failures occurred in later stages after implantation in 10 of 120 patients (8%).
  
  
  CONCLUSIONS
  Long-term follow-up of high-risk BrS patients with ICD showed a low incidence of VF in those aged >70 years. Considering the increasing risk of inappropriate shocks because of the relatively late onset of supraventricular tachycardia and lead failures, avoidance of ICD implantation, or replacement may be considered in elderly BrS patients who remain free from VF until 70 years of age.
authors.affiliation: From the Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (T. Kamakura, M.W., I.N., K.I., K.M., H.O., T.N., T.A., H.T., S.Y., H.O., W.S., S.K., K.K.); Division of Cardiology, Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T. Kamakura, T.M., T. Kimura); and Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.).
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Kamakura
authors.affiliation: From the Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (T. Kamakura, M.W., I.N., K.I., K.M., H.O., T.N., T.A., H.T., S.Y., H.O., W.S., S.K., K.K.); Division of Cardiology, Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T. Kamakura, T.M., T. Kimura); and Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.).
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Wada
authors.affiliation: From the Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (T. Kamakura, M.W., I.N., K.I., K.M., H.O., T.N., T.A., H.T., S.Y., H.O., W.S., S.K., K.K.); Division of Cardiology, Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T. Kamakura, T.M., T. Kimura); and Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.).
authors.forename: Ikutaro
authors.initials: I
authors.lastname: Nakajima
authors.affiliation: From the Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (T. Kamakura, M.W., I.N., K.I., K.M., H.O., T.N., T.A., H.T., S.Y., H.O., W.S., S.K., K.K.); Division of Cardiology, Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T. Kamakura, T.M., T. Kimura); and Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.).
authors.forename: Kohei
authors.initials: K
authors.lastname: Ishibashi
authors.affiliation: From the Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (T. Kamakura, M.W., I.N., K.I., K.M., H.O., T.N., T.A., H.T., S.Y., H.O., W.S., S.K., K.K.); Division of Cardiology, Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T. Kamakura, T.M., T. Kimura); and Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.).
authors.forename: Koji
authors.initials: K
authors.lastname: Miyamoto
authors.affiliation: From the Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (T. Kamakura, M.W., I.N., K.I., K.M., H.O., T.N., T.A., H.T., S.Y., H.O., W.S., S.K., K.K.); Division of Cardiology, Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T. Kamakura, T.M., T. Kimura); and Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.).
authors.forename: Hideo
authors.initials: H
authors.lastname: Okamura
authors.affiliation: From the Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (T. Kamakura, M.W., I.N., K.I., K.M., H.O., T.N., T.A., H.T., S.Y., H.O., W.S., S.K., K.K.); Division of Cardiology, Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T. Kamakura, T.M., T. Kimura); and Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.).
authors.forename: Takashi
authors.initials: T
authors.lastname: Noda
authors.affiliation: From the Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (T. Kamakura, M.W., I.N., K.I., K.M., H.O., T.N., T.A., H.T., S.Y., H.O., W.S., S.K., K.K.); Division of Cardiology, Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T. Kamakura, T.M., T. Kimura); and Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.).
authors.forename: Takeshi
authors.initials: T
authors.lastname: Aiba
authors.affiliation: From the Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (T. Kamakura, M.W., I.N., K.I., K.M., H.O., T.N., T.A., H.T., S.Y., H.O., W.S., S.K., K.K.); Division of Cardiology, Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T. Kamakura, T.M., T. Kimura); and Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.).
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takaki
authors.affiliation: From the Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (T. Kamakura, M.W., I.N., K.I., K.M., H.O., T.N., T.A., H.T., S.Y., H.O., W.S., S.K., K.K.); Division of Cardiology, Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T. Kamakura, T.M., T. Kimura); and Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.).
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yasuda
authors.affiliation: From the Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (T. Kamakura, M.W., I.N., K.I., K.M., H.O., T.N., T.A., H.T., S.Y., H.O., W.S., S.K., K.K.); Division of Cardiology, Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T. Kamakura, T.M., T. Kimura); and Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.).
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
authors.affiliation: From the Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (T. Kamakura, M.W., I.N., K.I., K.M., H.O., T.N., T.A., H.T., S.Y., H.O., W.S., S.K., K.K.); Division of Cardiology, Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T. Kamakura, T.M., T. Kimura); and Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.).
authors.forename: Wataru
authors.initials: W
authors.lastname: Shimizu
authors.affiliation: From the Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (T. Kamakura, M.W., I.N., K.I., K.M., H.O., T.N., T.A., H.T., S.Y., H.O., W.S., S.K., K.K.); Division of Cardiology, Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T. Kamakura, T.M., T. Kimura); and Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.).
authors.forename: Takeru
authors.initials: T
authors.lastname: Makiyama
authors.affiliation: From the Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (T. Kamakura, M.W., I.N., K.I., K.M., H.O., T.N., T.A., H.T., S.Y., H.O., W.S., S.K., K.K.); Division of Cardiology, Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T. Kamakura, T.M., T. Kimura); and Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.).
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
authors.affiliation: From the Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (T. Kamakura, M.W., I.N., K.I., K.M., H.O., T.N., T.A., H.T., S.Y., H.O., W.S., S.K., K.K.); Division of Cardiology, Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T. Kamakura, T.M., T. Kimura); and Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.). kamakura@hsp.ncvc.go.jp.
authors.forename: Shiro
authors.initials: S
authors.lastname: Kamakura
authors.affiliation: From the Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (T. Kamakura, M.W., I.N., K.I., K.M., H.O., T.N., T.A., H.T., S.Y., H.O., W.S., S.K., K.K.); Division of Cardiology, Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan (T. Kamakura, T.M., T. Kimura); and Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.).
authors.forename: Kengo
authors.initials: K
authors.lastname: Kusano
mesh_terms: D000328:Adult; D000368:Aged; D053840:Brugada Syndrome / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
keywords: Brugada syndrome; cardiac; death; defibrillators; implantable; myocardial ischemia; sudden; syncope