title: Asymptomatic Brugada Syndrome: Clinical Characterization and Long-Term Prognosis.
abstract: BACKGROUND
  Among Brugada syndrome patients, asymptomatic individuals are considered to be at the lowest risk. Nevertheless, arrhythmic events and sudden cardiac death are not negligible. Literature focused on this specific group of patients is sparse. The purpose of this study is to investigate the clinical characteristics, management, and long-term prognosis of asymptomatic Brugada syndrome patients.
  
  
  RESULTS
  Patients presenting with spontaneous or drug-induced Brugada type I ECG and no symptoms at our institution were considered eligible. A total of 363 consecutive patients (200 men, 55.1%; mean age, 40.9±17.2 years; 41 [11.3%] with spontaneous type I ECG) were included. Electrophysiological study was performed in 321 (88.4%) patients, and ventricular arrhythmias were induced in 32 (10%) patients. An implantable cardioverter defibrillator was implanted in 61 (16.8%) patients. After a mean follow-up time of 73.2±58.9 months, 9 arrhythmic events occurred, accounting for an annual incidence rate of 0.5%. Event-free survival was 99.0% at 1 year, 96.2% at 5 years, and 95.4% at 10 and 15 years. Univariate analysis identified as risk factors: electrophysiological study inducibility (hazard ratio, 11.4; P<0.01), spontaneous type I (hazard ratio, 4.0; P=0.04), and previous sinus node dysfunction (hazard ratio, 8.0; 95% confidence interval, 1.0-63.9; P=0.05). At the multivariate analysis, only inducibility remained significant (hazard ratio, 9.1; P<0.01).
  
  
  CONCLUSIONS
  Arrhythmic events in asymptomatic Brugada syndrome patients are not insignificant. Ventricular arrhythmia inducibility, spontaneous type I ECG, and presence of sinus node dysfunction might be considered as risk factors and used to drive long-term management.
authors.affiliation: From the Heart Rhythm Management Centre (J.S., G. Ciconte, G. Conte, G.-B.C., C.d.A., G.B., G.D.G., Y.S., G.I., J.J., K.W., G.P., P.B.) and Cardiac Surgery Department (M.L.M., F.W.), UZ Brussel-VUB, Brussels, Belgium; and Department of Cardiology, Erasme University Hospital, Brussels, Belgium (R.C.-A.). jasieira@gmail.com.
authors.forename: Juan
authors.initials: J
authors.lastname: Sieira
authors.affiliation: From the Heart Rhythm Management Centre (J.S., G. Ciconte, G. Conte, G.-B.C., C.d.A., G.B., G.D.G., Y.S., G.I., J.J., K.W., G.P., P.B.) and Cardiac Surgery Department (M.L.M., F.W.), UZ Brussel-VUB, Brussels, Belgium; and Department of Cardiology, Erasme University Hospital, Brussels, Belgium (R.C.-A.).
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ciconte
authors.affiliation: From the Heart Rhythm Management Centre (J.S., G. Ciconte, G. Conte, G.-B.C., C.d.A., G.B., G.D.G., Y.S., G.I., J.J., K.W., G.P., P.B.) and Cardiac Surgery Department (M.L.M., F.W.), UZ Brussel-VUB, Brussels, Belgium; and Department of Cardiology, Erasme University Hospital, Brussels, Belgium (R.C.-A.).
authors.forename: Giulio
authors.initials: G
authors.lastname: Conte
authors.affiliation: From the Heart Rhythm Management Centre (J.S., G. Ciconte, G. Conte, G.-B.C., C.d.A., G.B., G.D.G., Y.S., G.I., J.J., K.W., G.P., P.B.) and Cardiac Surgery Department (M.L.M., F.W.), UZ Brussel-VUB, Brussels, Belgium; and Department of Cardiology, Erasme University Hospital, Brussels, Belgium (R.C.-A.).
authors.forename: Gian-Battista
authors.initials: GB
authors.lastname: Chierchia
authors.affiliation: From the Heart Rhythm Management Centre (J.S., G. Ciconte, G. Conte, G.-B.C., C.d.A., G.B., G.D.G., Y.S., G.I., J.J., K.W., G.P., P.B.) and Cardiac Surgery Department (M.L.M., F.W.), UZ Brussel-VUB, Brussels, Belgium; and Department of Cardiology, Erasme University Hospital, Brussels, Belgium (R.C.-A.).
authors.forename: Carlo
authors.initials: C
authors.lastname: de Asmundis
authors.affiliation: From the Heart Rhythm Management Centre (J.S., G. Ciconte, G. Conte, G.-B.C., C.d.A., G.B., G.D.G., Y.S., G.I., J.J., K.W., G.P., P.B.) and Cardiac Surgery Department (M.L.M., F.W.), UZ Brussel-VUB, Brussels, Belgium; and Department of Cardiology, Erasme University Hospital, Brussels, Belgium (R.C.-A.).
authors.forename: Giannis
authors.initials: G
authors.lastname: Baltogiannis
authors.affiliation: From the Heart Rhythm Management Centre (J.S., G. Ciconte, G. Conte, G.-B.C., C.d.A., G.B., G.D.G., Y.S., G.I., J.J., K.W., G.P., P.B.) and Cardiac Surgery Department (M.L.M., F.W.), UZ Brussel-VUB, Brussels, Belgium; and Department of Cardiology, Erasme University Hospital, Brussels, Belgium (R.C.-A.).
authors.forename: Giacomo
authors.initials: G
authors.lastname: Di Giovanni
authors.affiliation: From the Heart Rhythm Management Centre (J.S., G. Ciconte, G. Conte, G.-B.C., C.d.A., G.B., G.D.G., Y.S., G.I., J.J., K.W., G.P., P.B.) and Cardiac Surgery Department (M.L.M., F.W.), UZ Brussel-VUB, Brussels, Belgium; and Department of Cardiology, Erasme University Hospital, Brussels, Belgium (R.C.-A.).
authors.forename: Yukio
authors.initials: Y
authors.lastname: Saitoh
authors.affiliation: From the Heart Rhythm Management Centre (J.S., G. Ciconte, G. Conte, G.-B.C., C.d.A., G.B., G.D.G., Y.S., G.I., J.J., K.W., G.P., P.B.) and Cardiac Surgery Department (M.L.M., F.W.), UZ Brussel-VUB, Brussels, Belgium; and Department of Cardiology, Erasme University Hospital, Brussels, Belgium (R.C.-A.).
authors.forename: Ghazala
authors.initials: G
authors.lastname: Irfan
authors.affiliation: From the Heart Rhythm Management Centre (J.S., G. Ciconte, G. Conte, G.-B.C., C.d.A., G.B., G.D.G., Y.S., G.I., J.J., K.W., G.P., P.B.) and Cardiac Surgery Department (M.L.M., F.W.), UZ Brussel-VUB, Brussels, Belgium; and Department of Cardiology, Erasme University Hospital, Brussels, Belgium (R.C.-A.).
authors.forename: Rubén
authors.initials: R
authors.lastname: Casado-Arroyo
authors.affiliation: From the Heart Rhythm Management Centre (J.S., G. Ciconte, G. Conte, G.-B.C., C.d.A., G.B., G.D.G., Y.S., G.I., J.J., K.W., G.P., P.B.) and Cardiac Surgery Department (M.L.M., F.W.), UZ Brussel-VUB, Brussels, Belgium; and Department of Cardiology, Erasme University Hospital, Brussels, Belgium (R.C.-A.).
authors.forename: Justo
authors.initials: J
authors.lastname: Julià
authors.affiliation: From the Heart Rhythm Management Centre (J.S., G. Ciconte, G. Conte, G.-B.C., C.d.A., G.B., G.D.G., Y.S., G.I., J.J., K.W., G.P., P.B.) and Cardiac Surgery Department (M.L.M., F.W.), UZ Brussel-VUB, Brussels, Belgium; and Department of Cardiology, Erasme University Hospital, Brussels, Belgium (R.C.-A.).
authors.forename: Mark
authors.initials: M
authors.lastname: La Meir
authors.affiliation: From the Heart Rhythm Management Centre (J.S., G. Ciconte, G. Conte, G.-B.C., C.d.A., G.B., G.D.G., Y.S., G.I., J.J., K.W., G.P., P.B.) and Cardiac Surgery Department (M.L.M., F.W.), UZ Brussel-VUB, Brussels, Belgium; and Department of Cardiology, Erasme University Hospital, Brussels, Belgium (R.C.-A.).
authors.forename: Francis
authors.initials: F
authors.lastname: Wellens
authors.affiliation: From the Heart Rhythm Management Centre (J.S., G. Ciconte, G. Conte, G.-B.C., C.d.A., G.B., G.D.G., Y.S., G.I., J.J., K.W., G.P., P.B.) and Cardiac Surgery Department (M.L.M., F.W.), UZ Brussel-VUB, Brussels, Belgium; and Department of Cardiology, Erasme University Hospital, Brussels, Belgium (R.C.-A.).
authors.forename: Kristel
authors.initials: K
authors.lastname: Wauters
authors.affiliation: From the Heart Rhythm Management Centre (J.S., G. Ciconte, G. Conte, G.-B.C., C.d.A., G.B., G.D.G., Y.S., G.I., J.J., K.W., G.P., P.B.) and Cardiac Surgery Department (M.L.M., F.W.), UZ Brussel-VUB, Brussels, Belgium; and Department of Cardiology, Erasme University Hospital, Brussels, Belgium (R.C.-A.).
authors.forename: Gudrun
authors.initials: G
authors.lastname: Pappaert
authors.affiliation: From the Heart Rhythm Management Centre (J.S., G. Ciconte, G. Conte, G.-B.C., C.d.A., G.B., G.D.G., Y.S., G.I., J.J., K.W., G.P., P.B.) and Cardiac Surgery Department (M.L.M., F.W.), UZ Brussel-VUB, Brussels, Belgium; and Department of Cardiology, Erasme University Hospital, Brussels, Belgium (R.C.-A.).
authors.forename: Pedro
authors.initials: P
authors.lastname: Brugada
mesh_terms: D000328:Adult; D053840:Brugada Syndrome / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000209:etiology; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis
keywords: Brugada syndrome; arrhythmias, cardiac; death, sudden, cardiac; defibrillators, implantable; prognosis