Risk stratification in Brugada syndrome: Clinical characteristics, electrocardiographic parameters, and auxiliary testing.
Risk stratification in Brugada syndrome remains a clinical challenge because the event rate is low but the presenting symptom is often cardiac arrest (CA). We review the data on risk stratification. A history of CA or malignant syncope is a strong predictor of spontaneous ventricular fibrillation (VF), whereas the prognostic value of a history of familial sudden death and the presence of a SCN5A mutation are less well defined. On the electrocardiogram, the presence of spontaneous type I electrocardiogram increases the risk for VF in all studies, whereas the presence of fragmented QRS complexes and early repolarization correlates with increased risk in several studies. Signal-averaged techniques using late potentials and microscopic T-wave alternans show some promising results in small studies that need to be confirmed. The value of electrophysiologic studies for predicting spontaneous VF remains controversial, and this includes programmed stimulation protocols that avoid a third extrastimuli or stimulation from the right ventricular outflow. Risk prediction is particularly challenging in children and women.
Departments of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler-School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Arnon
A
Adler
Departments of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler-School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Raphael
R
Rosso
Departments of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler-School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Ehud
E
Chorin
Departments of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler-School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Ofer
O
Havakuk
Cardiovascular Research Program, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania.
Charles
C
Antzelevitch
Departments of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler-School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: saviskin@tasmc.health.gov.il.
Sami
S
Viskin
D053840:Brugada Syndrome / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D006323:Heart Arrest / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*
Brugada syndrome; Cardiac arrest; Electrocardiogram; Electrophysiologic study; Risk stratification; Ventricular fibrillation